Regarding the Contract Process

    Application Form

    Business Name ( Required )

    Business Address ( Required )

    Attn: Responsible Party ( Required )

    Contact Information (Phone Number) - Required

    Contact Information (Email Address) Required

    ScanatEmail address for the administrator account ( required )

    If you have any other email addresses that require account registration, please enter them here.

    Device Rental Request (Type, Quantity)

    Please enter this information if the shipping address for the device is different from the address listed above.

    Please select a payment method. Required

    Please select a plan (tax included) Required

    Desired Start Month ( Required )

    *Note: "Scanat " counts the period from the 1st to the last day of the month as one month. Even if you start using the service in the middle of the month, you will be charged for one full month."

    ScanatHow I Found Out About It ( Required )


    Name of Referrer (excluding our sales representatives) Required

    * If there are no applicable individuals or if it is unclear, please enter "None."

    Notes

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