Ambiencia Information Systems, Inc

Ambiencia Services

More Information


	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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