ORDER FORM - ENTERPRISE SaaS - STATE OF WEST VIRGINIA
| Provider | [PROVIDER LEGAL NAME] |
| Customer | [CUSTOMER LEGAL NAME] |
| Product | [PRODUCT NAME] |
| Term | [X] months/years |
| Fees | $[AMOUNT] |
Payment: Net [30] days. West Virginia sales tax: 6% state + local.
Data Breach: W. Va. Code Section 46A-2A-101 et seq.
Venue: [Kanawha/Cabell] County, West Virginia.
SIGNATURES
Provider: _________________ Date: _______
Customer: _________________ Date: _______