ORDER FORM - ENTERPRISE SaaS - STATE OF INDIANA
| Provider | [PROVIDER LEGAL NAME] |
| Customer | [CUSTOMER LEGAL NAME] |
| Product | [PRODUCT NAME] |
| Term | [X] months/years |
| Fees | $[AMOUNT] |
Payment: Net [30] days. Indiana sales tax: 7%.
Data Breach: IC 24-4.9 compliance required.
Venue: [Marion/Hamilton/Allen] County, Indiana.
SIGNATURES
Provider: _________________ Date: _______
Customer: _________________ Date: _______