ORDER FOR EQUIPMENT / SERVICES RAINet, Inc. An RGnet Affiliate Network IP Service for Oregon & SW Washington P.O. NUMBER:_____________________ DATE:__________________________________ This P.O. number must appear on all related correspondence: (Please: Attach Purchase Order to this Form.) Send Invoice To: Ship To: ---------------------------------------------------------------------------- Name: _________________________ Name:__________________________________ Co: ___________________________ Co: ___________________________________ Addr: _________________________ Addr: _________________________________ Addr: _________________________ Addr: _________________________________ City/State/Zip__________________ City/State/Zip________________________ P.O. Date: ____________________ Requisitioner's Name __________________ Ship via: _____________________ FOB point: ____________________________ ---------------------------------------------------------------------------- NOTES: This Order Form MUST be mailed to the post office box address listed below, including signatures and purchase order, before the order can be processed. If the order exceeds $500, a check must be included for any amount in excess of $500. The remaining $500 will be billed with the first statement. Placing this order constitutes acceptance of RAINet Terms and Conditions. This order form does not include costs related to your own telephone company's installation and monthly charges, which cannot be known known until the order is placed, and which vary widely. Rough estimates of these costs are included on the price lists for infor- mation only. This order also, does not include one time charges for wiring from the demarc at the customer site to the installation wall, which will be billed to the customer after installation. Customers retain ownership of modems or CSU/DSU's purchased for placement at the POP, and equipment purchased through RAINet for placement at their site. Modem rental fees and port installation charges at the POP are non-refundable. Send all correspondence to: RAINet., Inc. -- Order Department P.O. Box 2522, Portland, OR 97208-2522 503.227-5665; Fax 503.297-9078 Email questions: help@rain.com Authorized by: ________________________Signature:__________________________ Title/Position: _______________________ Telephone #:________________________ (Read Equipment Section Carefully Before Ordering) TYPE Description unit price total ---------------------------------------------------------------------------- EQUIPMENT: Required for 14.4Kb Dedicated Line: 14.4Kb Modem (Intel 144e) at POP* 150 __________ Required for 28.8Kb Dedicated Line: 28.8Kb Modem rental at POP 250 __________ Required for Frame Relay: 56KB DSU/CSU (For Frame Relay - Requires 1) 250 __________ Router (Frame Relay) 1,650 __________ Required for 56/64Kb Leased-Line: 56Kb DSU/CSU (For Leased-Line - Requires 2) 500 __________ Router 1,650 __________ SERVICES: Set-Up Fee for All Full-Time Services 150 __________ (one time) PORT Installation at the POP 850 __________ (REQUIRED for 56KB Leased-Line only) (one time) Telco Setup Charge for Frame Relay/Leased-Line 450 __________ (one time) Telco Install fee for dedicated line at the POP 50 __________ (one time) Set-Up Fee for 14.4Kb SLIP/PPP dial-up (part-time) 20 __________ (one time) MONTHLY RATES (Each IP level includes news, e-mail mx, DNS): IP Service 56kb (Frame Relay or Leased-Line) 350 __________ 56Kb Frame Relay Telco Charges (US West) 150 __________ 56Kb Frame Relay Telco Charges (GTE) 160 __________ 56Kb Leased-Line Telco Charges __________ (Available by quote) IP Service, 28.8Kb (dedicated) 150 __________ IP Service, 14.4Kb (dedicated) 75 __________ 14.4Kb/28.8Kb dedicated Telco Charges at POP 27 __________ 14.4Kb/28.8Kb Customer End Telco charges ___ __________ (if needed) IP Service 14.4Kb SLIP/PPP Dial-up 20 __________ (10 hours per month -- $1 per additional hour) SUBTOTAL __________ (Washington State SALES TAX) __________ SHIPPING & HANDLING __________ TOTAL __________ *NOTE: RAINet requires use of the INTEL Faxmodem 144e at the POP for All dedicated 14.4Kb connections, the customers are free to use the modem of their choice on their end. Please Complete the Following Information to Facilitate Installation and Start-up. Technical Contact Person: _______________________Email Address:________________ Phone: ____________________________FAX:_______________________________ Best Times to Make Contact: ____________________________________________________ For 14.4Kb/28.8Kb Leased-Line or 14.4Kb dial-up services: SLIP or PPP? ____________________________________________________ Physical Address of Install Site: Street: __________________________________________________________________ City: ____________________________________ State: ______________________ Zip Code: ____________________________________ Tel #:( )_________________ 14.4Kb/28.8Kb Dedicated Service INSTALLATION NOTES: Normally, you arrange phone line installation at your own site, which is billed directly to you; and RAINet arranges phone line installation at the POP. You will receive a monthly statement from RAINet for the IP Service charge and the phone line at the POP. RAINet will, if requested, make arrangements for telephone line installations at both the POP site and your site. If you would like this option, please check the box below: Please arrange for all installation for the above order: |____| We understand that charges for both lines will appear on our monthly IP service statement. 56/64Kb LEASED-LINE & FRAME RELAY NOTES: RAINet will make all installation arrangements for Leased-Line and Frame Relay. You will receive a monthly statement with the IP Service charge and the telco charge from RAINet. 940808