2021 New Subscriber Form

Total Shop Management Subscription Order Form

Company Name

Federal Tax ID or SSN #

Please Confirm #

First Name

Last Name

Title/Position

Address

City

State/Province

ZIP/Postal Code

Phone Number

Fax Number

Email

Electronic Invoicing (EDI) Information

Safelite Parent ID#

LYNX Services Contract#

Select a eDirectGlass Subscription

Number of Additional User Licenses, $84.95 per user, per month.

Number of Additional User Licenses, $109.95 per user, per month.

Number of Non-Pricing User Licenses, $9.95 per user, per month.

Number of Mobile Technician Licenses @ $9.95 per month - (Optional)

Subscription Add-on Options

MailChimp Integration | $24.95 per month Web Quote License $99.95 monthlly Web Quote Lite, up to 100 quotes, each additional quote is $.25 License $49.95 per month QuickBooks Setup $129.95 Reputation Management | $250 per month Social Media AI Quote, Schedule Chat Bot $199.95 per month

Method of Payment

Mastercard Visa American Express Discover

Name as it appears on credit card

Credit Card #

Expires: (xx/xx)

CVV #

Is the Credit Card Billing Address the same as the address above?

Address

City

State/Province

ZIP/Postal Code

By Clicking the "Subscribe" button below, I agree that I have entered all of the information to the best of my knowledge. I further agree that I have read the License Agreement in its entirety. I hereby authorize AMJ Logistics, Inc. /D/B/A/ eDirectGlass, to bill my credit card the license fee(s) and the recurring monthly fee(s) as described in this agreement.

I also agree that I acknowledge the following statements, by way of checkbox, as it pertains to the Agreement:

Rejected Electronic Invoices (EDI) that are resubmitted will be billed at the rate of $0.50 each. Cancellation of subscription or service downgrade requires 30-day written notice. If a Premium or Premium-Plus user license is terminated prior to 9 months from start date of the license, the regular monthly fee ($84.95 or $109.95 based on subscription type) will multiplied by remaining months, up to 12 months, will be charged and is due. All licenses for Premium or Premium-Plus service are based-on a 12 month period. All licenses for any add-on service are based-on a 12 month period. If a add-on service is terminated prior to the 12 month period from start date of the license, the add-on-subscription fee will be multiplied by remaining months, up to 12 months, will be charged and is due.

Pay-Per-Invoice Edition Conditions

Any Submitted Invoice is (EDI/Electronic, Email, or Printed) is billed at the rate of $5.00 each Cancellation of subscription or service downgrade requires 30-day written notice. All licenses for any add-on service are based-on a 12 month period. If a add-on service is terminated prior to the 12 month period from start date of the license, the add-on-subscription fee will be multipled by remaining months, up to 12 months, will be charged and is due.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date this online form is submitted.