Enrollment Request Received

REF: ABT-XXXXXX

Your request has been submitted. Coverage is not active yet. ABT will review device eligibility, confirm the selected plan, establish billing, and send written activation confirmation before service begins or any charge is made.

Back to ABT Concierge Contact ABT

1 Your Organization

Company / Organization Name *

Primary Contact Name *

Business Email Address *

Phone Number * Enter a 10-digit U.S. phone number. It will format automatically as (555) 555-5555. Used only when needed to clarify enrollment or activation details; Concierge support requests remain email-based.

Existing ABT Customer? *

Yes No

2 Primary Service Location

City *

State *

ZIP Code *

Additional Locations if requesting multi-location coverage

3 Plan & Devices *

Single Device $7.95/mo One enrolled device Small Office $24.95/mo One location, 2–5 devices Medium Office $39.95/mo One location, 6–10 devices Larger Fleet Custom More than 10 devices or multiple locations

Number of Devices *

Device Type(s) *

Selecting the Single Device plan automatically sets the device count to 1.

Manufacturer and Model(s) * Most business-class printers, scanners and MFPs are eligible, subject to compatibility review before activation.

4 Current Equipment Support

Current Support Relationship *

Provider Name if applicable

Under Agreement or Warranty? optional

Yes No Not sure

Questions or Special Requirements optional

5 Support Authorization & Terms

Who May Submit Concierge Support Requests? *

Any employee using our company email domain Designated employees only Primary contact only at activation

Remote-access approvers, full service addresses, device serial numbers and detailed coordination contacts are confirmed during activation.

I am authorized to request this service for the organization. I understand that ABT Concierge has a 12-month service term; the organization may cancel with 30 days' written notice without a cancellation penalty; submitting this form is an enrollment request rather than immediate activation; coverage begins only after ABT confirms eligibility and sends written activation notice; and support is limited to enrolled devices and the Concierge service scope, subject to reasonable business use.

No charges are made when this form is submitted. ABT will review the request and contact the organization to confirm device eligibility, service terms, billing and activation.

ABT will review the request and follow up using the business email provided. Coverage begins only after written activation confirmation. Questions? Contact ABT directly.