Application to Add Kiosk to QikKids Database

This application is for clients who wish to add Kiosk to their database.

COMPANY DETAILS

Company/Group name

Company/Group name*

Street*

Suburb*

State*

Postcode*

PRIMARY CONTACT DETAILS *
(PLEASE MAKE SURE YOU HAVE THE AUTHORITY TO REQUEST THIS CHANGE)

PRIMARY CONTACT DETAILS*

First Name * Last Name *

Email Address*

Phone Number (incl. Area Code)*

SECONDARY CONTACT DETAILS
(PLEASE MAKE SURE YOU HAVE THE AUTHORITY TO REQUEST THIS CHANGE)

SECONDARY CONTACT POINT

First Name Last Name

Email Address

Phone Number (incl. Area Code)

EXISTING DATABASE DETAILS

Current Database Name*

Support ID of 1 service on database*

Number of Kiosk licenses requested*

Kiosk (By ticking this box, I accept that I will be charged $345 per Kiosk licence per annum for this service. This will be charged in advance for the number of licenses you order. 1 licence is required per CCSS licensed service.)*

I accept the terms and conditions for Kiosk*

Kiosk (By ticking this box, I accept that I will be charged $360 per Kiosk licence per annum for this service. This will be charged in advance for the number of licenses you order. 1 licence is required per CCSS licensed service.)

Interested in getting Kiosk Hardware? (iPad, Kiosk Stand, Site specific configuration $906.95 excl. GST)
CLICK HERE to complete a form to arrange your hardware order. Please note this is separate to this Kiosk software order.

Comments

I accept the terms and conditions associated with the use and billing of Kiosk and the conditions of the First 30 Days Free opportunity.*

terms and conditions

Do you already have a Direct Debit arrangement with QK Technologies?*

Yes
No

CAPTCHA

COMPANY DETAILS

Company/Group name

PRIMARY CONTACT DETAILS * (PLEASE MAKE SURE YOU HAVE THE AUTHORITY TO REQUEST THIS CHANGE)

SECONDARY CONTACT DETAILS (PLEASE MAKE SURE YOU HAVE THE AUTHORITY TO REQUEST THIS CHANGE)

EXISTING DATABASE DETAILS

PRIMARY CONTACT DETAILS *
(PLEASE MAKE SURE YOU HAVE THE AUTHORITY TO REQUEST THIS CHANGE)

SECONDARY CONTACT DETAILS
(PLEASE MAKE SURE YOU HAVE THE AUTHORITY TO REQUEST THIS CHANGE)