Purchase Order (PO) Form
VanDyke Software, Inc.

This form does not replace your Company’s PO, it will simply provide us with all 
the information we require to process your purchase order as quickly as possible.

PO's can be faxed to VanDyke Orders at 1-505-332-5701, or sent via email to 
sales@vandyke.com.


BILLING INFORMATION. Required fields are marked with an asterisk(*):


*Purchasing Contact: ___________________________ *Fax: _________________________

*Accounts Payable Contact: _____________________________________________________

*Company: ______________________________________________________________________

*Billing Address: ______________________________________________________________

*City, State, Zip: _____________________________________________________________

*AP Phone: ______________________________ *AP Fax: _____________________________


LICENSE REGISTRATION & DELIVERY INFORMATION. Required fields are marked with an 
asterisk(*): 


*End-user Contact Name: ________________________________________________________

*End-user Company: _____________________________________________________________

*Shipping Address: _____________________________________________________________

*City, State, Zip: _____________________________________________________________

*Phone: _____________________________ *Email: _________________________________

Industry: ______________________________________________________________________

Number of Employees: ___________________ Number of Locations: __________________

Dun & Bradstreet (D&B) Number: _________________________________________________ 

Standard Industrial Classification (SIC) Code: _________________________________


*For upgrade or Maintenance orders, please include current serial number(s):
 
________________________________________________________________________________


If your PO includes terms and conditions, please include them with your order. 
Payment terms are Net 30.  Payment must be in U.S. dollars drawn on a U.S. Bank.


You will receive a Purchase Order Acknowledgment when we receive your completed 
PO and PO Form. In most cases, License information will be sent via email within 
1 to 2 business days.