Blue Moon for Ultrasound Support Agreement

Please complete the included form and select the desired support option. If you would like to contact us to discuss your support options, feel free to email our support team at KMHA-IST@gcp.konicaminolta.com

End User Location

KMHA Account #

Account Name

Address

Address Line 2

City/Town

State/Province

ZIP/Postal Code

Main Phone

Contact Name

Contact Title

Contact Email

Billing Same as Contact

Billing Information

Billing Account Name

Address

Address Line 2

City/Town

State/Province

ZIP/Postal Code

Billing Phone

Billing Contact Name

Billing Contact Email

Step 1: Select a plan

A) Blue Moon Elite

CON1103
Term: 3 Years
Annual Payment: $4,885

B) Blue Moon Prime

UE00EX5
Term: 3 Years
Annual Payment: $3,910

C) Annual Extended Warranty

UE00EC8
Term: 3 Years
Annual Payment: $2,160

D) Waive coverage

I understand that there will be a $300/hr charge per support event.

Step 2: Payment

Pay By Credit Card

Contact me for credit card payment

please provide the best phone number & time(s) to reach you

Pay later

We will send an invoice for payment by check, bank transfer, or credit card

Pay by Purchase Order

PO Number

Please also provide a hard copy of the PO.
This PO # will be used for the length of the agreement unless Konica Minolta receives a replacement PO # prior to the billing schedule.

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