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Technical Support Registration Form

 

Billing Information:

Agency Name

Address:

City: 

State/Province

<or> Other

Zip/Postal
Contact Information:

First Name

Last Name

E-mail*

Work Phone 

Fax Phone

Child Tracking Software:

Contract Start Date:

Contract End Date:

Login:

Password:

Confirm Password:

:

 

Support Type: 

 

Entry Level

Primary Level

Enhanced Level

Premium Level

Basic

$699.00

$795.00

$1595.00

  

Standard

$1495.00

$2495.00

$3495.00

$4495.00

Advanced

$2995.00

$3995.00

$4995.00

$6995.00

Per Incident

$75.00

Call Anytime!

    

Web Support

$299.00

      

Free Support

FREE

 For web discussions and download center access only

Discounts:

 Not available for per incident or web support!

Total Amount:
Additional Contacts
Fill in the following for each person that will be contacting Technical Support.
2nd Contact Name:
2nd Contact Email:
3rd Contact Name:
3rd Contact Email:
4th Contact Name:
4th Contact Email:
5th Contact Name:
5th Contact Email:
Billing Information
* Method of Payment:
PO#

Card No.  Expiration Date

Authorizing Manager:
Check this box if your billing address is the same as your Agency information.
Billing Address:
Additional Comments
Comments:

*required fields
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