Mobile Device Security, Anit-theft, and Management

Android Phones

INSTALLTION SERVICES - PURCHASE FORM

  (#S403-3) - Mobile Device Security and Anti-Theft Software Installation - 3 Devices for 3 years

PRICE: $990.00

PURCHASE DATE: ______________ TOTAL AMOUNT AND/OR RENEWAL PRICE AUTHORIZED BY CLIENT: $990.00

AUTHORIZED SIGNATURE  FOR PRICE/AMOUNT DUE AND PAYMENT METHOD USED (i.e., Credit Card, Check, PO# ):_________________________________________________________________________

I AGREE TO PAY THE ABOVE TOTAL AMOUNT ACCORDING TO THE CARD ISSUER AGREEMENT FOR THE LISTED/INPUTTED CLIENT CREDIT CARD AND/OR FOR THE PURCHASE NUMBER (PO#) LISTED.  ALL SALES ARE FINAL.  NO REFUNDS.   I AGREE TO ALL GUIDELINES, NDAs, POLICIES, AND PROCEDURES OF COMMBASE TECHNICAL SOLUTIONS, LLC AND EXECUTED CONTRACTS WITH COMMBASE TECHNICAL SOLUTIONS, LLC PRIOR TO ANY SERIVCES OR PRODUCTS PURCHASED. I AGREE TO PAY FOR THE ABOVE RENEWAL PRICE LISTED ABOVE ACCORDING TO THE CARD ISSUER AGREEMENT FOR THE ABOVE LISTED CREDIT CARD FOR THE RENEWAL PURCHASE PRICE TO RENEW THE SERVICES AND LICENSE/PRODUCT STATED ABOVE. UPON ME CLICKING ON THE "PAY NOW" BUTTON BELOW", I AGREE TO ALL THE ABOVE STATEMENTS AND I AUTHORIZE AND APPROVE MY DIGITAL SIGNATURE TO BE ENTERED HERE AND ON THE NEXT PAGE AFTER I CLICK THE "SUBMIT" BUTTON.

Service Date Scheduled/Requested:___________    Service Time Scheduled/Requested:___________   Payment Confirmed :____________  Receipt#:_________________Email Confirmation Sent;_____

CLIENT NAME:___________________________________        BILLING ADDRESS:____________________________________________________   

TELEPHONE#:_________________________     CELL#:______________________        FAX#:_________________________

E-MAIL(Billing):____________________________________ E-MAIL(Notifications):_________________________________________

COMPANY NAME: __________________________________________ADDRESS:_______________________________________________________ 

TELEPHONE#:__________________________    CELL#:______________________       FAX#:__________________________

E-MAIL(Billing):____________________________________  E-MAIL(Notifications):_________________________________________

(Internal Use Only)

Payment & Registration Processed: Fax Order_____    Telephone Order_____    e-Commerce_____

Marketing Representative ID#:______________________  Telephone#:________________ Cell#:________________  Email:_____________________

WO#:____________    Date Completed:_______________  Approved Spiff/ID#:_________________

Cash: Yes___  No____ Amount Paid :______________________________
Check: Bank_____ Personal____    Business____ Check # ____________________   DL#____________________  (optional) Expiration____________ State:_________
Credit Card Used (selct one):  Visa:________________/Exp:_________     MC: ________________/Exp:__________    Discover:________________/Exp: _________  AMEX: _______________/Exp: ________   JCB:________________/Exp:__________    Debit (Visa)___________________/Exp:____________    Debit (MC)_____________________/Exp______________      ( CVV_______ )  
P.O. #:_______________________________________________________________ Gift Certificate #:_______________________________________________________
CommBase Technical Solutions, LLC
Attn: Sales Departent / Technical Services Departmnt
109 E. 17th Street * Suite 5089 * Cheyenne, WY * 82001
Tel: (307) 773-0124, ext. 1003 * Fax: (877) 335-0603 * Email: e-sales@commbasetech.com

 

 
 
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