SimpleChurch - Giving Kiosk Purchase Form

TYPE OF KIOSK AND QUANTITY
Floor Stand Kiosk	*  Choose Quantity 1 Floor Stand Kiosk  (Add $1,499.00)2 Floor Stand Kiosks  (Add $2,998.00)3 Floor Stand Kiosks  (Add $4,497.00)4 Floor Stand Kiosks  (Add $5,996.00)5 Floor Stand Kiosks  (Add $7,495.00)6 Floor Stand Kiosks  (Add $8,994.00)7 Floor Stand Kiosks  (Add $10,493.00)8 Floor Stand Kiosks  (Add $11,992.00)9 Floor Stand Kiosks  (Add $13,491.00)10 Floor Stand Kiosks  (Add $14,990.00)11 Floor Stand Kiosks  (Add $16,489.00)12 Floor Stand Kiosks  (Add $17,988.00)13 Floor Stand Kiosks  (Add $19,487.00)14 Floor Stand Kiosks  (Add $20,986.00)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 $1,199.00)2 Table Mount Kiosks  (Add $2,398.00)3 Table Mount Kiosks  (Add $3,597.00)4 Table Mount Kiosks  (Add $4,796.00)5 Table Mount Kiosks  (Add $5,995.00)6 Table Mount Kiosks  (Add $7,194.00)7 Table Mount Kiosks  (Add $8,393.00)8 Table Mount Kiosks  (Add $9,592.00)9 Table Mount Kiosks  (Add $10,791.00)10 Table Mount Kiosks  (Add $11,990.00)11 Table Mount Kiosks  (Add $13,189.00)12 Table Mount Kiosks  (Add $14,388.00)13 Table Mount Kiosks  (Add $15,587.00)14 Table Mount Kiosks  (Add $16,786.00)
Wall Mount Kiosk	*  Choose Quantity 1 Wall Mount Kiosk  (Add $1,099.00)2 Wall Mount Kiosks  (Add $2,198.00)3 Wall Mount Kiosks  (Add $3,297.00)4 Wall Mount Kiosks  (Add $4,396.00)5 Wall Mount Kiosks  (Add $5,495.00)6 Wall Mount Kiosks  (Add $6,594.00)7 Wall Mount Kiosks  (Add $7,693.00)8 Wall Mount Kiosks  (Add $8,792.00)9 Wall Mount Kiosks  (Add $9,891.00)10 Wall Mount Kiosks  (Add $10,990.00)11 Wall Mount Kiosks  (Add $12,089.00)12 Wall Mount Kiosks  (Add $13,188.00)13 Wall Mount Kiosks  (Add $14,287.00)14 Wall Mount Kiosks  (Add $15,386.00)
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	$