Online Backup Form – Without Direct Debit

Pharmacy Name *

Contact Person *

Phone Number

Email *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Chose Your Plan *

5 GB - $45 ex gst /month - Ideal for POS & Dispense data backup
10 GB (Most Popular) - $55 ex gst /month - Ideal for POS & Dispense PLUS Nominated 3rd party software data backup
20 GB - $75 ex gst /month - Ideal for POS & Dispense PLUS Nominated 3rd party software & documents folders data backup
30 GB - $85 ex gst /month - Ideal for POS & Dispense PLUS Nominated 3rd party software & documents folders data and email history backup
50 GB - $89 ex gst /month -CPD Bonanza Plan (Backup everything)

Your POS Software *

Your Dispense Software *

(Available for plans of 10GB or more. Required quota will be adjusted accordingly)

Chose 3rd party software and data to backup

Other software or folders

Proposed installation/start date

EOD Time (backups should run after the EOD) *

Email address to receive daily backup reports *

Name *

Signature *

Date *

Terms & Conditions