Request for Additional Medtech Evolution License(s) on Medtech Cloud

 
 
Customer No.*
 
 
 
 
Customer Name*
 
 
 
 
Requestor’s Name*
 
 
 
 
Requestor’s Position*
 
 
 
 
Email:*
 
 
 
 
Phone Number*
 
 
 
 
Date required for this to be actioned*
 
 
 
 
 
 
I/We require an additional Medtech Cloud license(s) @ $500 + GST per License. How many licences do you require?
 
 
 
 
 
 
 
Note: Go to Help/Register option on the Menu Bar and use a snipping tool to take a screenshot. If the snipping tool is not available, please do CTRL + SHIFT + Print Scrn and then paste it on a word document. Please save it on your computer and upload that file 
 
 
 
Upload a copy of your current Medtech Evolution licensing screen *
 
 
 
 
 
Privacy Policy
 
 
I have read and accept the Privacy Policy and I am authorised to make this commitment on behalf of my organisation.*
 
 
I/We Acknowledge that our monthly support and development fees will increase by 1 workstation fee per additional license*
 
 
      See Privacy Policy 
 
 
NOTE: There is a 24 hour turn around period on new license details