2014-2015 Pay-Per-Return NEW Order Form Please complete a separate form for each EFIN and/or location. 109 Custer Terrace • Bettendorf, IA 52722 • 563.344.9613 • Fax 888-473-3995 • E-mail: [email protected] *= Required Fields *Firm Name_ _______________________________________ Shipping Address, if Different (No Post Office Boxes) *DBA_ _______________________________________ Address Line 1_____________________________________________ *Primary Contact_ _______________________________________ Address Line 2_____________________________________________ Secondary Contact ________________________________________ City, ST, Zip_____________________________________________ *Address Line 1_ _______________________________________ Delivery Instructions for UPS (100 characters or less): Address Line 2_ _______________________________________ ___________________________________________________________ *City, ST, Zip_ _______________________________________ ___________________________________________________________ *EFIN (6 digit number) _________________________________ Drake Account # ________________________________________ *# of Additional Sites for Firm_______________________________ *Primary Phone # ________________________________________ *Owner(s) of Firm ________________________________________ Cell Phone # ________________________________________ *EIN _____________________ or *SSN_ _________________________ Fax # ________________________________________ *Email Address _ _____________________________________________ *Entity Type ■ Individual/Sole Proprietor ■ Corp ■ LLC-Corporate ■ Other ■ Tax-Exempt ■ Partnership ■ LLC-Single Member ■ LLC-Partnership New Customer Information Tax Software Used for 2013 Taxes__________________________________ Conversion to Drake –Yes ■ No ■ (see list of available conversions) How did you learn about Drake? ____________________________________ _________________________________________________________________ DESCRIPTION COST • Drake Software 2014 - Includes ALL States Pay-Per-Return (PPR) Option includes 15 returns (Additional Returns can be purchased for $20 each) ............................... (Upgrade to Full Unlimited Package - 85 Returns OR $1,700) No CWU - $0 Client Write-Up ...........................................................................................................................................$ TOTAL COST - $300 $ PPR300 295 $ FREE $ $300.00 • CHOOSE ONE OF THREE DELIVERY OPTIONS .■ 1. Download Only - NO CDs..............................................................................................$ . Sales Tax - All States & Jurisdictions (Except: AK, AR, CA, DC, DE, FL, GA, HI, IA, ID, MD, MO, MT, NH, NJ, NV, OK, OR, SC, and VA): 39 ■ 2. CD Shipment - ONLY First Two CDs and Archive CD...........................................$ . Sales Tax - All States & Jurisdictions (Except: AK, DC, DE, HI, ID, MT, NH, and OR): ■ 3. CD Shipment - ALL CDs...............................................................................................$ FREE $ No CD's $0 79 $ No CD's $0 . Sales Tax - All States & Jurisdictions (Except: AK, DC, DE, HI, ID, MT, NH, and OR): $ 0.00 $ 0.00 = State, County and City Sales Tax based on Shipping Address and Delivery Method - Enter Total Rate _______% • Document Manager, Tax Planner, e-Filing (Fed & State)...........................................$ International shipping: Contact the accounting department for rates Reminder: Tax research may be purchased by visiting Support.DrakeSoftware.com I agree to the terms and conditions of the Drake Software 2014 License and Non-Disclosure Agreement. *_ ______________________________ *_________________________ Signature Required Date of Order Print & Sign (e-mailed order forms will NOT be accepted) License agreement: http://www.drakesoftware.com/PDF/license2014.pdf System requirements: http://www.drakesoftware.com/PDF/sysreq2014.pdf Make Checks Payable To: ($25 charge and termination of service for returned checks) John Johannesen John Johannesen & Associates , LLC 109 Custer Terrace Bettendorf, IA 52722 Fax 888.473.3995 FREE $ FREE $ 300.00 TOTAL $ _________________________ ■ CHECK ■ VISA ■ MASTERCARD ■ DISCOVER ■ AMEX Card Number:_______________________________ Exp Date:___________ Security Code: CC Billing Address:_____________________________________________ ___________________________________________ CVV_______________ (Please Print) Cardholder’s Name_____________________________________________ Signature______________________________________________________ Print & Sign (e-mailed order forms will NOT be accepted)