CSS Pricing and Order | FORM Packages and More Company Contact InformationCompany Name* Corporate or Entity Name Authorized Agent Name* First Last Billing Address* Street Address City State / Province / Region ZIP / Postal Code Email Address for Authorized Agent* Enter Email Confirm Email Business Telephone Number*Business FAX number*Mobile Phone NumberCSS Packages and Service LevelsWe prefer to brand each SMS system in the following construct: WWW.___________SAFETY.COM* Please provide your ideal URL name here.CSS Package Pricing* Premium-Enhanced system full features PLUS custom branding to match corporate site look with Customized SMS “Safety Management System” and Customized On-Boarding and retail curriculum tools to include: Electronic Signature, Work Flow Approval, and electronic test for a Company Specific On-Boarding program. Total $0.00 Managed Monthly Service Level* $100.00 BASIC MONTHLY SUPPORT (introductory offer) includes: hosting, licensing, updates, back-up and 24 hour monitoring. See Service agreement for more details about services. Fine print and InstructionsDigital Signature* By Clicking the "SUBMIT" Button below, you will automatically be sent to another document with all of the specific details for review. By clicking "SUBMIT" you are not obligating yourself to anything at this time. You will need to review the "Agreement for Services" and digitally sign it before you are obligated to anything. Signature