Site Location Input Form (25 available entries)

Practice / Company Name*

Primary Contact*

First Name Last Name

Primary Contact Phone #*

Primary Contact Email Address*

Check the box below to enter site location information.*

continue

SITE LOCATION #1*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #1 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #1 - How many media players will be installed in this location?*

SITE LOCATION #1 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)*

Click the "+" sign to add a new line for each media player

SITE LOCATION #1 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #1 - WIFI Network Name

SITE LOCATION #1 - WIFI Network Password

SITE LOCATION #1 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #1 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 2nd Site Location?

Check if "Yes"

SITE LOCATION #2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #2 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #2 - How many media players will be installed in this location?

SITE LOCATION #2 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #2 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #2 - WIFI Network Name

SITE LOCATION #2 - WIFI Network Password

SITE LOCATION #2 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #2 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 3rd Site Location?

Check if "Yes"

SITE LOCATION #3

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #3 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #3 - # of media players to be installed in the 3rd location

SITE LOCATION #3 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #3 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #3 - WIFI Network Name

SITE LOCATION #3 - WIFI Network Password

SITE LOCATION #3 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #3 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 4th Site Location?

Check if "Yes"

SITE LOCATION #4

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #4 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #4 - # of media players to be installed in the 4th location

SITE LOCATION #4 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #4 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #4 - WIFI Network Name

SITE LOCATION #4 - WIFI Network Password

SITE LOCATION #4 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #4 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 5th Site Location?

Check if "Yes"

SITE LOCATION #5

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #5 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #5 - # of media players to be installed in the 5th location

SITE LOCATION #5 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #5 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #5 - WIFI Network Name

SITE LOCATION #5 - WIFI Network Password

SITE LOCATION #5 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #5 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 6th Site Location?

Check if "Yes"

SITE LOCATION #6

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #6 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #6 - # of media players to be installed in the 6th location

SITE LOCATION #6 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #6 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #6 - WIFI Network Name

SITE LOCATION #6 - WIFI Network Password

SITE LOCATION #6 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #6 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 7th Site Location?

Check if "Yes"

SITE LOCATION #7

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #7 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #7 - # of media players to be installed in the 7th location

SITE LOCATION #7 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #7 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #7 - WIFI Network Name

SITE LOCATION #7 - WIFI Network Password

SITE LOCATION #7 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #7 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 8th Site Location?

Check if "Yes"

SITE LOCATION #8

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #8 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #8 - # of media players to be installed in the 8th location

SITE LOCATION #8 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #8 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #8 - WIFI Network Name

SITE LOCATION #8 - WIFI Network Password

SITE LOCATION #8 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #8 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 9th Site Location?

Check if "Yes"

SITE LOCATION #9

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #9 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #9 - # of media players to be installed in the 9th location

SITE LOCATION #9 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #9 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #9 - WIFI Network Name

SITE LOCATION #9 - WIFI Network Password

SITE LOCATION #9 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #9 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 10th Site Location?

Check if "Yes"

SITE LOCATION #10

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #10 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #10 - # of media players to be installed in the 10th location

SITE LOCATION #10 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #10 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #10 - WIFI Network Name

SITE LOCATION #10 - WIFI Network Password

SITE LOCATION #10 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #10 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 11th Site Location?

Check if "Yes"

SITE LOCATION #11

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #11 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #11 - # of media players to be installed in the 11th location

SITE LOCATION #11 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #11 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #11 - WIFI Network Name

SITE LOCATION #11 - WIFI Network Password

SITE LOCATION #11 - Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #11 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 12th Site Location?

Check if "Yes"

SITE LOCATION #12

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #12 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #12 - # of media players to be installed in the 12th location

SITE LOCATION #12 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #12 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #12 - WIFI Network Name

SITE LOCATION #12 - WIFI Network Password

SITE LOCATION #12- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #12 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 13th Site Location?

Check if "Yes"

SITE LOCATION #13

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #13 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #13 - # of media players to be installed in the 13th location

SITE LOCATION #13 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #13 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #13 - WIFI Network Name

SITE LOCATION #13 - WIFI Network Password

SITE LOCATION #13- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #13 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 14th Site Location?

Check if "Yes"

SITE LOCATION #14

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #14 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #14 - # of media players to be installed in the 14th location

SITE LOCATION #14 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #14 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #14 - WIFI Network Name

SITE LOCATION #14 - WIFI Network Password

SITE LOCATION #14- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #14 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 15th Site Location?

Check if "Yes"

SITE LOCATION #15

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #15 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #15 - # of media players to be installed in the 15th location

SITE LOCATION #15 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #15 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #15 - WIFI Network Name

SITE LOCATION #15 - WIFI Network Password

SITE LOCATION #15- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #15 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 16th Site Location?

Check if "Yes"

SITE LOCATION #16

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #16 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #16 - # of media players to be installed in the 16th location

SITE LOCATION #16 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #16 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #16 - WIFI Network Name

SITE LOCATION #16 - WIFI Network Password

SITE LOCATION #16- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #16 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 17th Site Location?

Check if "Yes"

SITE LOCATION #17

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #17 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #17 - # of media players to be installed in the 17th location

SITE LOCATION #17 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #17 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #17 - WIFI Network Name

SITE LOCATION #17 - WIFI Network Password

SITE LOCATION #17- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #17 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 18th Site Location?

Check if "Yes"

SITE LOCATION #18

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #18 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #18 - # of media players to be installed in the 18th location

SITE LOCATION #18 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #18 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #18 - WIFI Network Name

SITE LOCATION #18 - WIFI Network Password

SITE LOCATION #18- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #18 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 19th Site Location?

Check if "Yes"

SITE LOCATION #19

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #19 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #19 - # of media players to be installed in the 19th location

SITE LOCATION #19 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #19 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #19 - WIFI Network Name

SITE LOCATION #19 - WIFI Network Password

SITE LOCATION #19- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #19 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 20th Site Location?

Check if "Yes"

SITE LOCATION #20

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #20 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #20 - # of media players to be installed in the 20th location

SITE LOCATION #20 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #20 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #20 - WIFI Network Name

SITE LOCATION #20 - WIFI Network Password

SITE LOCATION #20- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #20 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 21st Site Location?

Check if "Yes"

SITE LOCATION #21

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #21 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #21 - # of media players to be installed in the 21st location

SITE LOCATION #21 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #21 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #21 - WIFI Network Name

SITE LOCATION #21 - WIFI Network Password

SITE LOCATION #21- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #21 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 22nd Site Location?

Check if "Yes"

SITE LOCATION #22

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #22 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #22 - # of media players to be installed in the 22nd location

SITE LOCATION #22 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #22 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #22 - WIFI Network Name

SITE LOCATION #22 - WIFI Network Password

SITE LOCATION #22- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #22 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 23rd Site Location?

Check if "Yes"

SITE LOCATION #23

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #23 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #23 - # of media players to be installed in the 23rd location

SITE LOCATION #23 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #23 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #23 - WIFI Network Name

SITE LOCATION #23 - WIFI Network Password

SITE LOCATION #23- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #23 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 24th Site Location?

Check if "Yes"

SITE LOCATION #24

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #24 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #24 - # of media players to be installed in the 24th location

SITE LOCATION #24- Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #24 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #24 - WIFI Network Name

SITE LOCATION #24 - WIFI Network Password

SITE LOCATION #24- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #24 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a 25th Site Location?

Check if "Yes"

SITE LOCATION #25

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

SITE LOCATION #25 - Who will be the contact for this location?*

Use Primary Contact
Provide Alternate Contact

First Name Last Name

Phone #

Email Address

SITE LOCATION #25 - # of media players to be installed in the 25th location

SITE LOCATION #25 - Provide a nickname for each media player in this location (ex. South Lobby, Exam Room 1)

Click the "+" sign to add a new line for each media player

SITE LOCATION #25 - If this location will be using a WIFI network connection, would you like the network name and password to be pre-loaded on the media player(s)?

Yes
No, thank you.

OPTIONAL - WIFI information can also be added during the installation, using a USB keyboard and mouse.

SITE LOCATION #25 - WIFI Network Name

SITE LOCATION #25 - WIFI Network Password

SITE LOCATION #25- Would you like the media player(s) shipped directly to this site location?

Yes
No, I'd like to provide an alternate shipping address

SITE LOCATION #25 - Alternate shipping address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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