Secure Order Form for DBI Staff-Scheduler
Order Information:
(
*
indicates required field)
QTY:
Product:
DBI Staff-Scheduler Pro - $789.00 (USD)
Contact
DBI Sales
for 5 or more licenses
Licensee Information:
MID Codes
(enter codes for up to 4 machines)
*
Site Codes
(enter codes for up to 4 machines)
*
Name
*
Title
Organization
Street address
*
Address (cont.)
City
*
State/Province
*
Zip/Postal code
*
Country
*
Phone
FAX
Email
*
Web Address (URL):
Payment Method:
Credit card
Please select ....
VISA
MasterCard
American Express
*
Or Call DBI Sales
Cardholder name
*
(800) 670-8045 (in North America)
Card number
*
(204) 985-5770
Expiration date
*
Comments: