Instant Evaluate
920 East Semoran Blvd
Casselberry, Fl. 32707
Fax: 407-834-2207
Store Service Order Form

- Please complete one form per Store -
Franchisee Information:
Owner Name   *
Total # of Stores Owned 
Store Information:
PC Number *
   Location Name *
   Store Address *
   City *
State   Zip 
Phone   Fax    
Email  *  
- Service Order Terms -
Monthly pricing per store
Billed to Credit Card Quarterly
   $9 Service Charge per month (billed in advance)
   45¢ per Ohone Survey *
   10¢ fee per Internet survey
   - Survey Fees billed after service is provided
   $19 Start-up Kit includes Store Signage and 600 Custom Color Survey Coupons
(Survey Coupons encourage customer participation).

* Additional Custom Survey Coupons may be printed by store from the Instant Evaluate web site, or store may purchase additional custom color survey coupons from Instant Evaluate for $19 (plus shipping) per 600.
Questions and Comments:
Print Name   *   
Card Number  *   
Billing Address   *   
City   *   
                   Title  *
  Credit Card Type  *
              Expires   *
State   * Zip   *
The following terms and conditions apply to this agreement.
  * Each owner will receive an individual username & password to view their store service reports from the Internet.
* Stores may cancel service at any time with 30-day written notice.
* Instant Evaluate may discontinue service due to non-payment.
* Each party confirms that it has full power and authority to enter into and perform this Agreement.
* Store agrees to the terms specified above.
  I agree to all terms and conditions specified in the agreement above.