ASQ Enterprise

* indicates a required field

1. *ASQ Enterprise is for multisite programs. Does your program have more than one site?

Yes No

2. *ASQ Enterprise manages both ASQ-3 and ASQ:SE (English and Spanish) questionnaire data. To use ASQ Enterprise, each site MUST own a print version of the corresponding questionnaires that they will be managing in the system. Does each site in your program currently own the corresponding questionnaires that they are interested in running in ASQ Enterprise?

Yes No

3. *To set up your account, please enter your information below.

*Organization Name:

*State/Province:

*Country:

4. *Please provide contact information for either the person who will be responsible for overseeing the account or if you do not have the information at this time, a person that we can follow-up with. A Brookes Publishing representative will contact this individual in the next few days to set up your ASQ Enterprise account.

*Prefix:

*First Name:

*Last Name:

*Email Address:

*Phone Number:

*The above contact is:

5. In addition to the annual subscription fee for ASQ Enterprise, you will be charged quarterly for the aggregate screening usage of all the sites in your program. If you are purchasing ASQ Enterprise using a credit card, this credit card will be charged automatically on a quarterly basis for screening usage.

I give Brookes Publishing permission to charge my credit card quarterly.

6. To ensure uninterrupted access, we offer automatic renewal for ASQ Enterprise annual subscriptions. If you purchase ASQ Enterprise using a credit card, in future years, annual subscription fees can be charged automatically to this credit card.

I give Brookes Publishing permission to charge ASQ Enterprise renewal fees to my credit card.