**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 2017-2018 NEW Order Form Please complete a separate form for each EFIN and location. *= 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 ___________________________________ _____________________________________________________ COST TOTAL COST ■ CHECK ■ VISA ■ MASTERCARD ■ DISCOVER ■ AMEX Card Number: ___________________________________________ Exp Date:_______________________________ CVV _____________ CC Billing Address: _______________________________________ ________________________________________________________ Cardholder’s Name _______________________________________ Signature _______________________________________________ (Please Print) Print & Sign (e-mailed order forms will NOT be accepted) New Customer Information Tax Software Used for 2016 Taxes ____________________________ Conversion to Drake –Yes ■ No ■ (See List of Available Conversions) How Did You Learn About Drake? ____________________________ _________________________________________ I agree to the terms and conditions of the Drake Software 2017 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/license2017.pdf System requirements: http://www.drakesoftware.com/PDF/sysreq2017.pdf FREE FREE Subtotal: TOTAL ** If you haven’t already done so, please fax your IRS e-file Application Summary to 828.349.5733. DESCRIPTION • Drake Tax 2017 - Includes ALL States April & May - $1,095; June & July - $1,195; August & September - $1,295; October & November - $1,395; December 1 and After - $1,495 .................................................... $ • 2016 Software Bundle Option - Unlimited 2016 Package (Prior Year) with e-filing Included ............ $ • Client Write-Up ................................................................................................................................. $ • Document Manager, Tax Planner, e-Filing (Fed & State) ................................................................. $ CHOOSE ONE OF THREE DELIVERY OPTIONS 1. Download Only - NO CDs .......................................................................................... $ 3. CD Shipment - ALL CDs............................................................................................ $ Sales Tax - All States & Jurisdictions (Except: AK, DC, DE, HI, ID, MT, NH, and OR): State, County and City Sales Tax based on Shipping Address and Delivery Method - Enter Total Rate ______________ = International shipping: Contact the accounting department for rates 99 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): ■ 2. CD Shipment - ONLY First Two CDs and Archive CD ..................................................... $ 49 Sales Tax - All States & Jurisdictions (Except: AK, DC, DE, HI, ID, MT, NH, and OR): FREE 300 FREE FREE (Input Value as a Decimal) 1914 South ‘S’ Street • Fort Smith, AR 72901 • 800.382.0787 or 800.890.9500 • Fax 479.782.3047 • Email: [email protected] Make Checks Payable To: ($25 charge and termination of service for returned checks) Drake Software 1914 South ‘S’ Street Fort Smith, AR 72901 Fax 479.782.3047 Orders subject to Janes, Inc. Terms and Privacy Statement available from [email protected].