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

Customer No.*
Customer Name*
Requestor’s Name*
Requestor’s Position*
Phone Number*
Date required for this to be actioned*
I/We require an additional Medtech Cloud license(s). 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