**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 FormPlease 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 OrderPrint & Sign (e-mailed order forms will NOT be accepted)License agreement: http://www.drakesoftware.com/PDF/license2017.pdfSystem requirements: http://www.drakesoftware.com/PDF/sysreq2017.pdf

FREEFREE

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 StatesApril & 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 OPTIONS1. 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 ..................................................... $ 49Sales Tax - All States & Jurisdictions (Except: AK, DC, DE, HI, ID, MT, NH, and OR):

FREE300

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: Maggie@Drake1040.com

Make Checks Payable To: ($25 charge and termination of service for returned checks)

Drake Software1914 South ‘S’ StreetFort Smith, AR 72901 Fax 479.782.3047

Orders subject to Janes, Inc. Terms and Privacy Statement available from Maggie@Drake1040.com.

Firm Name: DBA: Address Line 1: Primary Contact: Address Line 2: Secondary Contact: City ST ZIP: Address Line 1_2: Address Line 2_2: City ST ZIP_2: Delivery Instructions for UPS 100 Characters or Less 1: Delivery Instructions for UPS 100 Characters or Less 2: EFIN 6Digit Number: Drake Account: of Additional Sites for Firm: Primary Phone: Owners of Firm: Cell Phone: EIN: or SSN: Fax: Email Address: Tax Software Used for 2016 Taxes: Other: OffTaxExempt Partnership: OffHow Did You Learn About Drake: LLCPartnership: OffMASTERCARD: OffCard Number: Exp Date: CVV: CC Billing Address 2: Unit Cost: [$0]Total CD Cost: [0.0]Subtotal: 0Sales Tax Rate: 0Sales Tax Total: 0Total: 02016 Software Option: [0.00]How Did You Learn About Drake 2: No: OffYes: OffCorp: OffPartnership: OffIndividualSole Proprietor: OffLLC-Corporate: OffLLC-Single Member: OffCHECK: OffVISA: OffDISCOVER: OffAMEX: OffCC Billing Address 1: Cardholder's Name: Date of Order: