Purchase License Request
Miromaa Purchase License Request Form

IMPORTANT Instructions

You are completing this form because you are requesting to purchase Miromaa Licenses.

Please foreward seperately to us a Purchase Order form with all necessary details to fax no 02 4925 2185 as well as completing the below form details.

Pricing is as follows:

1 to 4 licenses @ $550 each license (Full price – no discount)
5 to 10 licenses @ $360 each license (saving of approx. 33%)
11 or more licenses @ $275 each license (saving of approx. 50%)
All pricing includes GST

Please ensure that you do not qualify to obtain Miromaa via our sponsorship, if you do qualify we will provide Miromaa to you free of charge.

By completing this form I understand that I may be contacted for further information in regards to my language activities in the context of how Miromaa may be used and my suitability to receive Miromaa.

We reserve the right to refuse purchases of Miromaa which could be used in situations which we deem inappropiate.

This license if granted will permit me to install Miromaa on a computer for the specified organisations use only.

If you have any questions in how to complete this form please do not hesitate to contact us, we cant wait to help you obtain Miromaa.

Fields marked with a * are mandatory and missed be filled in.
Name of Organisation (*)
Please add a value for Name of Organisation
Community Name (*)
Please add a value for Community Name.
Language Name/s (*)
Please add a value for Language Name/s.
Number of Licenses Requested (*)
Please add a value for Number os Licenses.

E.G. If you have a desktop computer and a laptop you may want to install Miromaa on both, if so request 2 licenses. You can always request more licenses if needed, just complete this form again at a later stage.
Address (*)
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Site Address (*)
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Phone Number (*)
is not a number.
Email Address (*)
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Web Address
Name of Person completing this form (*)
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