Technical Support Agreement

Please complete the included form, select the desired support option, and return to us via email or fax.

Fax: 248-632-1162 | Email: susan@greatlakesimaging.com

End User Location

Account Name

Address

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

Main Phone

Contact Name

Contact Title

Contact Email

Billing Same as Contact

Billing Information

Billing Account Name

Billing Address

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

Billing Phone

Billing Contact Name

Billing Contact Email

Step 1: Select a plan

A) Technical Support

Software Only

Annual Payment Options:

$1200 / 1 Year

$960 / 3 Year

$750 / 5 Year

Monthly Payment Options:

$105 a month / 1 Year

$90 a month / 3 Year

$72 a month / 5 Year

Pay Annually or Monthly?

Annually

Monthly

Annual Payment Options

$1200 / 1 Year

$960 / 3 Year

$750 / 5 Year

Monthly Payment Options

$105 a month / 1 Year

$90 a month / 3 Year

$72 a month / 5 Year

B) Cloud Backup

(Can be purchased alone or in addition to Plan A)

Annual Payment Options

$425 / 5 Year

C) Waive coverage

I understand there will be a $250/hr charge per support event

Step 2: Select a Payment Method

* You will be redirected to our payment portal upon form submission.

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Have questions? Contact us today!

Each medical setting — an office, clinic, or hospital — has different needs, and deserves a customized approach to medical imaging and equipment. Let our knowledgeable staff assist in customizing solutions for your practice. Call or contact Great Lakes Imaging today!

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32369 Milton Ave.
Madison Heights, MI 48071

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586.268.9200