Kindrid Giving - Kiosk Purchase Form

TYPE OF KIOSK AND QUANTITY
Floor Stand Kiosk	*  Choose Quantity 1 Floor Stand Kiosk  (Add $1,699.00)2 Floor Stand Kiosks  (Add $3,398.00)3 Floor Stand Kiosks  (Add $5,097.00)4 Floor Stand Kiosks  (Add $6,796.00)5 Floor Stand Kiosks  (Add $8,495.00)6 Floor Stand Kiosks  (Add $10,194.00)7 Floor Stand Kiosks  (Add $11,893.00)8 Floor Stand Kiosks  (Add $13,592.00)9 Floor Stand Kiosks  (Add $15,291.00)10 Floor Stand Kiosks  (Add $16,990.00)11 Floor Stand Kiosks  (Add $18,689.00)12 Floor Stand Kiosks  (Add $20,388.00)13 Floor Stand Kiosks  (Add $22,087.00)14 Floor Stand Kiosks  (Add $23,786.00)1 Card Reader Only  (Add $80.00)2 Card Readers Only  (Add $160.00)3 Card Readers Only  (Add $240.00)4 Card Readers Only  (Add $320.00)
Table Mount Kiosk	*  Choose Quantity 1 Table Mount Kiosk  (Add $1,399.00)2 Table Mount Kiosks  (Add $2,798.00)3 Table Mount Kiosks  (Add $4,197.00)4 Table Mount Kiosks  (Add $5,596.00)5 Table Mount Kiosks  (Add $6,995.00)6 Table Mount Kiosks  (Add $8,394.00)7 Table Mount Kiosks  (Add $9,793.00)8 Table Mount Kiosks  (Add $11,192.00)9 Table Mount Kiosks  (Add $12,591.00)10 Table Mount Kiosks  (Add $13,990.00)11 Table Mount Kiosks  (Add $15,389.00)12 Table Mount Kiosks  (Add $16,788.00)13 Table Mount Kiosks  (Add $18,187.00)14 Table Mount Kiosks  (Add $19,586.00)
Wall Mount Kiosk	*  Choose Quantity 1 Wall Mount Kiosk  (Add $1,299.00)2 Wall Mount Kiosks  (Add $2,598.00)3 Wall Mount Kiosks  (Add $3,897.00)4 Wall Mount Kiosks  (Add $5,196.00)5 Wall Mount Kiosks  (Add $6,495.00)6 Wall Mount Kiosks  (Add $7,794.00)7 Wall Mount Kiosks  (Add $9,093.00)8 Wall Mount Kiosks  (Add $10,392.00)9 Wall Mount Kiosks  (Add $11,691.00)10 Wall Mount Kiosks  (Add $12,990.00)11 Wall Mount Kiosks  (Add $14,289.00)12 Wall Mount Kiosks  (Add $15,588.00)13 Wall Mount Kiosks  (Add $16,887.00)14 Wall Mount Kiosks  (Add $18,186.00)
CONTACT INFORMATION
Contact Name	*
Contact Phone Number	*
ACCOUNT INFORMATION
Organization URL/Website	*
Your Email Address	*
SHIPPING WILL BE BILLED SEPARATE FROM THIS TRANSACTION There is a monthly maintenance fee of $19/month per kiosk.
SHIPPING INFORMATION
Shipping Address Line 1	*
Shipping Address Line 2
Shipping City	*
Shipping State	*
Shipping Zip	*
Additional Comments
Total	$