This form registers your devices for the trade-up cash back program. It also helps to expedite your credit against the purchase of new/current devices. With the looming end of support for Microsoft XP, now is the time to get your people the technology they need.

First Name *

Last Name *

Company Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Email Address *

Please tell us about the devices you would like to trade-in for cash back

What make and model(s) device would you like to trade in? *

How many units will you be trading in for cash back? Note: Must be in working order with AC adapter, battery & stylus. *

What Brand(s)?

Will you be using our HIPAA Compliant Disposal Services? Note: Working and non-working units are eligible for this FREE $100 value. *

Yes

No

What brand of replacement devices will you be acquiring for your team?

Please check the model or models you are considering *

I would like to have my new devices in the hands of my people within *

Do you have questions about the program?

Yes. Please have my Rep call me immediately to discuss our options

Anything else you would like to add? Your requests and/or comments will receive a swift and courteous response. Thank you!

Additional Comments

0/255 characters

ASAP	30 Days	60 Days	90 Days	Greater than 90 Days
Not sure