Contract Request Form Page

Name*
Employee's First & Last Name requesting this contract.
Email*
Please enter your Xtend email.
Ticket # (if applicable):
Please enter the relevant Zendesk ticket number.
Product/Service/Contract requested*
Please enter the product/service/contract details, including any relevant info such as packages.
Are there any other employees who should see this contract?*
- Yes
- No
What is the employee's name?
Employee's First & Last Name
CU Name*
CU Number/ID*
Please enter a number from 0 to 9999.

Setup Fees
Enter any setup fees.
Ongoing Base Fees*
Any ongoing fees, such as annual, quarterly, monthly, or any other base fees.
Per-item Fees
Any ongoing variable per-item fees, such as per email, per call, per transaction, etc.
Pricing Notes
If there are any discounts, promotional rates, exceptions, etc, please include them here.
Is this a Scholarship Request?*
- Yes
- No
Is this a Discount Rate?*
- Yes
- No