FIZ PatMon Order | FIZ Karlsruhe

Current FIZ PatMon Order
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Shipping Address

First name*

Last name*

Institution*

Street/P.O.Box*

Postcode/City*

Country*

EMail*

Phone*

Purchase Order Number

VAT Reg. No.

Invoice should be sent

by mail as hardcopy

by email as PDF

Email for the invoice

Billing Address

Institution

Street/P.O.Box

Postcode/City

Country

User

Each user will be provided her/his personal password. The email address will be used as loginid.
Please list all users incl. user role.

Full name	Email	User role
Full name	Email	User role
Full name	Email	User role
Full name	Email	User role
Full name	Email	User role
Full name	Email	User role
Full name	Email	User role
Full name	Email	User role
Full name	Email	User role
Full name	Email	User role
Full name	Email	User role

If you require access for more than 10 users, please indicate contact person and company name, and provide an additional list with Name, First Name, E-mail Address, and User Role for each user in a separate mail to service [at] fiz-karlsruhe.de (subject: PatMon%20%3E10%20Loginids) (customer service).

Comments

Terms and Conditions*

I accept FIZ Karlsruhe´s General Terms and Conditions for Licensing the FIZ PatMon Service and agree to the storage and processing of my personal data according to article 3 clause 3 of said General Terms and Conditions.

Personal Data*

Yes, I accept that FIZ Karlsruhe can use my personal data for product-specific user information about FIZ PatMon. I agree, that I can revoke my consent at any time.

No, I do not accept that FIZ Karlsruhe can use my personal data for product-specific user information about FIZ PatMon.

I order a FIZ PatMon 1 year licence for:

Maximum number of cases*

100

420.00 EUR excl. 19% VAT

499.80 EUR incl. 19% VAT

780.00 EUR excl. 19% VAT

928.20 EUR incl. 19% VAT

1130.00 EUR excl. 19% VAT

1344.70 EUR incl. 19% VAT

1470.00 EUR excl. 19% VAT

1749.30 EUR incl. 19% VAT

1700.00 EUR excl. 19% VAT

2023.00 EUR incl. 19% VAT

2280.00 EUR excl. 19% VAT

2713.20 EUR incl. 19% VAT

3045.00 EUR excl. 19% VAT

3623.55 EUR incl. 19% VAT

All fields marked with * have to be filled in