Calcium Hosting Service for:

   Name:     __________________________________________________________

   Company:  __________________________________________________________

   Email:    __________________________________________________________



   Calcium Hosting Service -   4 calendars         $20/month  ___ 
                              10 calendars         $35/month  ___
                              25 calendars         $65/month  ___
                             100 calendars        $100/month  ___

   Options - add 20% to base monthly charge for each:
     Email Reminders and Subscriptions                add 20% ___
     Custom Fields                                    add 20% ___


   Term
                                                     3 months ___
                                                     6 months ___
                                                    12 months ___ (10% discount)


   Total: ..................................................  _________

      E.g. 10 calendars + Email Reminders + Custom Fields for 12 months:
           ($35 + $7 + $7) * 12 * 90% = $529.20   


   Check enclosed, or Credit Card info:

       Card# _____________________________  Exp. Date:______

       Card Type:  Visa __      MasterCard __      American Express __
        
       Name on Card: _____________________________