Nuevo cliente, formulario de venta oficial de Arbrea

Please fill here all new customer’s detail

Full Name
*

First

Last Name
*

Last

Email

Phone

Total Sales Value

Sales type:

New customer

Renewal

Customer Upgrade

Other type (ex. to distributor)

Address
*

Address

Street Address

Building/Suite/Apartment #

City

State/Province

Zip/Postal

Country

Address

Does the sale include any device that needs to be shipped?
*

Yes

No

Shipping Info

Full Name
*

First

Last Name
*

Last

Address
*

Address

Street Address

Building/Suite/Apartment #

City

State/Province

Zip/Postal

Country

Address

Please Describe the payment method and payment situation

Credit Card

Product

Payment Period

Monthly Payment

Yearly Payment

Device payment + monthly

Other (Please describe below)

License Period

12 months

24 months

36 months

Other type (please add info on notes)

Please describe here special conditions, pricing etc

Is the doctor account created already?

No, please create his account with the indicated email

Yes, already created by the customer, need to activate his plan

No action required.

Seller Name or Names

Is an invoice required?

Yes please send invoice asap

Already sent

Let me check and I’ll let you know