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Remote Manager Order Form

Please complete the following form to place your order for Remote Manager. If you have any questions, please contact your Sales Representative at 1-800-997-6724.

* = required fields

Please complete a separate form for each store that will receive a copy of Remote Manager.

Remote Manager requires RMS Platinum in all store locations.

BSMGR Account#:*
Contact Name:*
Store Name:*
Address:*
Address (cont.):
City:*
State:*	Select One... AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MI - Michigan MN - Minnesota MO - Missouri MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PE - Prince Edward Island RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming
Zip:*
Country:*
Phone:*
Fax:
Email:*
Version of Microsoft Windows Running on the computer with Remote Manager:*	Select One... Windows 2003 Standard Server Windows XP Professional Windows XP Home Windows 2000 Advance Server Windows 2000 Server Windows 2000 Professional Windows NT 4.0 Server Windows NT 4.0 Workstation Windows Vista Home Basic 32-bit Windows Vista Home Basic 64-bit Windows Vista Home Premium 32-bit Windows Vista Home Premium 32-bit Windows Vista Business 32-bit Windows Vista Business 64-bit Windows Vista Premium 32-bit Windows Vista Premium 64-bit
Comment:

NOTE: The iRMS package includes 1 hour of pre-paid setup support.