ORDER FORM - ENTERPRISE SaaS - COMMONWEALTH OF PENNSYLVANIA
| Provider | [PROVIDER LEGAL NAME] |
| Customer | [CUSTOMER LEGAL NAME] |
| Product | [PRODUCT NAME] |
| Term | [X] months/years |
| Fees | $[AMOUNT] |
Payment: Net [30] days. Pennsylvania sales tax: 6% state + local.
Data Breach: 73 Pa.C.S. Section 2301 et seq.
Venue: [Philadelphia/Allegheny] County, Pennsylvania.
SIGNATURES
Provider: _________________ Date: _______
Customer: _________________ Date: _______