Order – OH-NWC

NEW BIM OHIO NATIONAL WEBCHECK FINGERPRINT SYSTEM ORDER FORM

Please completely fill out and submit this form if you have discussed your quote with Sales and wish to purchase an Ohio National Webcheck fingerprint system from BIM.

If you have not yet received a quote and spoken with Sales, please contact sales@bioinfomgt.com or call (614) 456-1296 opt. 2 for a quote.

If you wish to purchase more than one fingerprint system, please submit one complete form for each system or location. Alternatively, please coordinate with Sales on sending in a custom location list along with a signed quote.

"*" indicates required fields

Agency Information

Agency Name*

Enter the name of your agency, company organization, entity, etc.

Agency Address*

There is where we will ship your fingerprint system.

Address Line 1 Address Line 2 City State ZIP Code

County*

BCI Agency Code*

Your 6-digit Agency Code provided by Ohio BCI. If you do not yet have an Agency Code from Ohio BCI, please check the box to the right.

No BCI Agency Code

I do not yet have a BCI Agency Code

You must apply for and provide your Ohio BCI Agency Code to BIM before we can deliver your fingerprint system.

Contact Information

Primary Contact Name*

The primary buyer or organizer for the fingerprint system within your agency.

First Last

Primary Contact Phone #*

Primary Contact Email Address*

LSA/Technical Contact Name*

Live Scan Administrator or Technical contact; who we may contact for Support.

First Last

LSA/Technical Contact Phone #*

LSA/Technical Contact Email Address*

Billing Contact Name*

Person responsible for handling A/R or A/P for the fingerprint system.

First Last

Billing Contact Phone #*

Billing Contact Email Address*

Billing Address (optional)

Check here if your billing address is the same as your agency address

Billing Address (if different than agency address)

It is only necessary to complete the billing address fields IF your billing address differs from your agency address.

Address Line 1 Address Line 2 City State ZIP Code

Purchase Information

Are you tax exempt?*

If you answer YES for your agency, you must submit your Ohio Sales Tax Exemption Certificate to accounting@bioinfomgt.com.

Would you prefer to purchase a laptop or desktop computer with your BIM Fingerprint System?*

You must purchase a new computer from BIM for your new BIM fingerprint system. Please choose either a Laptop or Desktop computer that BIM will provide.

Would you like to purchase any of these optional add-ons?

Roller Case

Additional 12 months of Support

Adding one or more of these optional additions will increase the price of your system purchase, which will be reflected on your invoice. Please refer to your quote for pricing.