Customer Order Form

Organization Full Name:

Organization Abbreviation:

Billing Contact Full Name:

Title / Position:

E-mail address:

A confirmation e-mail containing order details will be sent to this address.

Phone:

Address 1:

Address 2:

City:

State / Province:

Zip / Postal Code:

Country:

iMIS version:

Licensed to:

Licensed Users:

Serial Number:

iMIS Staff Site Url:

iMIS REST Endpoint:

iMIS RESTful Endpoint URL for cloud products if known

NiUG Member:

Yes
No
Unsure

Learn more about NiUG.

Cloud Products:

Other Products:

Number of integration(s) for SSO:

Only required if SSO was selected above. Specify the number of integration(s) you would like to license that will be using the product.

iMove Address Block:

Only needed if iMove was selected above. See the iMove product page for pricing.

Domain name(s) for PageFilter:

Only required if PageFilter was selected above. Specify the list of domain name(s) you would like to license that will be using the product.

Other Notes:

Would you like to proceed with the 3 Year prepay discount provided to you by CSI?:

Yes
No
I did not receive a quoted prepay discount, please send to me

Legal: For all products other than CSI Cloud Products, the licenses are governed by the End User License Agreement available here: https://www.csiinc.com/eula, which is incorporated herein. Your installation and/or use of the software constitutes your binding acceptance of the End User License Agreement. For all CSI Cloud products, the licenses are governed by the Software as a Service Agreement available here : https://www.csiinc.com/SaaS, which is incorporated by reference herein. Your access and/or use of the application constitutes your binding acceptance of the Software as a Service Agreement.

Customer Order Form

Customer Information

iMIS Information

Product Selection (select all that apply)