For Contract Procedures

    Application Form

    Business Name ( Required )

    Business Address ( Required )

    Attn: Contact Person ( Required )

    Contact Information (Phone Number) Required

    Contact Information (Email Address) Required

    Email address for the Scanat administrator account ( required )

    Please enter any other email addresses that require account registration.

    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 )

    *Please note that " Scanat " counts the period from the 1st to the last day of the month as one month. If you start using the service in the middle of the month, you will be charged for the full month.

    How I first heard about Scanat ( Required )


    Name of Referrer (excluding our sales representatives) Required

    * If there are no applicable individuals or if their status is unknown, please enter "None."

    Notes

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