Ambiencia Services  
     
 
 
     
     
     
     
     
     
     
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For more information about the services, please contact us at
sales@ambiencia.com

 

RENEWAL ORDER FORM

 
 
Thank you for choosing our products as part of your solutions.
Please note that in order to assure continued support, all Galaxy licenses still in use in your institution with expired Maintenance and Support contracts must be renewed. Direct all inquiries to sales@ambiencia.com, we are glad to respond to them quickly.
 
Fields marked with an "•" must be completed to process your purchase.
My Information
   

Your Name:

   

Company Name:

   
Developer numbers or Maintenance numbers for each license that need M&S to be renewed:
 

Your E-mail:

 
Billing Information
   
Billing process:
I first need a quote

I first need an invoice
Billing address:
Same as the shipping address

Other than the shipping address, and is provided below

Billing address, if other than the shipping address (Line 1):

Billing address, if other than the shipping address (Line 2):

City:

Province/Region/State:

Postal/Zip Code:

Country:
 
 

 

 
 
   
   
   
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