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https://www.quotevalet.com/concierge.aspx?DocumentId=cdb15aef-595b-45f1-92c6-bb84c0e7fee9&TenantId=abac8cd1-263a-4179-98c0-...
Submission: On June 06 via manual from US — Scanned from DE
Submission: On June 06 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
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<!-------------------------------------- Messages / Alerts -------------------------------------->
<!-------------------------------------- Tenant Internal -------------------------------------->
<!-------------------------------------- Outer -------------------------------------->
<div id="outer">
<!-------------------------------------- Top Banner -------------------------------------->
<!-------------------------------------- Letterhead -------------------------------------->
<div id="letterhead" class="section">
<img style="margin:20px;" id="letterhead-logo" src="/TenantSiteData/Access002/DefaultLetterHeadLogo.jpg">
<div id="letterhead-details">
<div id="tenant-website">
<a href="www.AccessSystems.com">www.AccessSystems.com</a>
</div>
<div id="tenant-address"> 1208 West 51st Street, Suite 1, Sioux Fallls, SD 57105 </div>
</div>
</div>
<!-------------------------------------- Quote Details Section -------------------------------------->
<div class="section-separator">
<div class="section-item toggle-button">
</div>
<div class="section-item"> Quote ASTQ32718</div>
</div>
<div id="quote-details-section" class="section">
<div id="expiration-date"> Valid through June 20, 2023 @ 1:48 pm </div>
<div id="prepared-for" class="prepared-item">
<h4> Prepared For:</h4>
<div> AVERA MILBANK AREA HOSPITAL</div>
<div> Rhonda . </div>
<div> Phone: (605) 432-4538</div>
<div> 301 FLYNN DRIVE</div>
<div>
</div>
<div>
</div>
<div> MILBANK, SD 57252</div>
<div> michell.griese@avera.org</div>
</div>
<div id="prepared-by" class="prepared-item">
<h4> Prepared By:</h4>
<div> Mike Staudenmier</div>
<div> Sales Manager</div>
<div> Phone: 605.338.0330</div>
<div> Fax: 605.338.0911</div>
<div> Email: Mike@tssphones.com</div>
</div>
<div id="prepared-by-pictures" class="prepared-item">
<div>
</div>
<div>
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<div id="pdf-section" class="content-001">
<div id="pdf-description-b">
<!--<a href= "FileDownload.aspx?Context=1&ContextId=aa92e01b-ce57-450e-b18b-01310f0ffb69&TenantId=abac8cd1-263a-4179-98c0-30c58bfbc729&OriginatingTemplateId=7ca82a12-e230-4595-a461-9e00c6cca7ce&Internal=0" target="QuotePDF">Click here</a> to download and view the PDF version of this quote. You can sign and fax this in, or you can save time by simply electronically accepting this quote below.-->
<p> Below is the interactive version of the quote, you can choose options and see the quote totals. </p>
<p style="line-height:150%;font-size:11px;"> For the full presentation proposal,
<a href="FileDownload.aspx?Context=1&ContextId=aa92e01b-ce57-450e-b18b-01310f0ffb69&TenantId=abac8cd1-263a-4179-98c0-30c58bfbc729&OriginatingTemplateId=7ca82a12-e230-4595-a461-9e00c6cca7ce&Internal=0" target="QuotePDF">click here</a>
to view or download the PDF version of this quote. <strong>Alternatively, you can print and scan to email to <a href="mailto:itorders@accesssystems.com">IT Orders</a>, fax to 515-987-6228, or you can save time by simply electronically
accepting this quote below.</strong>
</p>
</div>
</div>
</div>
<!-------------------------------------- Line Items Section -------------------------------------->
<div class="section-separator">
<div class="section-item toggle-button">
</div>
<div class="section-item"> Line Item Detail</div>
</div>
<div id="line-items-section" class="section">
<table id="line-item-detail-table" class="table-001">
<tbody>
<tr>
<th>
</th>
<th> QTY </th>
<th> Description </th>
<th> Picture </th>
<th> Unit Price </th>
<th> Ext Price </th>
</tr>
<tr class="row-group-header">
<td class="col-option-box">
</td>
<td class="col-qty"> 1 </td>
<td colspan="1" class="col-description"> 2 Plantronics CS-540 Headsets<br>2 Plantronics APU76 EHS Interface Cables<br><br>Ship Direct to Hospital Attn: Nadean Kovarik </td>
<td class="col-picture">
</td>
<td class="col-unit-price"> $716.00 </td>
<td class="col-extended-price"> $716.00 </td>
</tr>
</tbody>
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<div>
<input type="submit" name="QV_SubmitOptions" value="Update Totals" id="QV_SubmitOptions" class="submit-options">
</div>
<div id="totals-area">
<table id="totals-table">
<tbody>
<tr class="row-subtotal">
<td class="col-description"> SubTotal: </td>
<td class="col-amount"> $716.00 </td>
</tr>
<tr class="row-shipping">
<td class="col-description"> Shipping: </td>
<td class="col-amount"> $0.00 </td>
</tr>
<tr class="row-tax">
<td class="col-description"> Sales Tax: </td>
<td class="col-amount"> $0.00 </td>
</tr>
<tr class="row-total">
<td class="col-description"> Total: </td>
<td class="col-amount"> $716.00 </td>
</tr>
</tbody>
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</div>
</div>
<div class="modal-background lightbox">
<div class="modal-window" style="position: absolute; top: 570px; left: 770px;">
<img class="lightbox-image" alt="lightbox image" src="">
<span class="button ok"></span>
</div>
</div>
<!-------------------------------------- Acceptance Section -------------------------------------->
<div class="section-separator">
<div class="section-item toggle-button">
</div>
<div class="section-item"> Ready to Accept? </div>
</div>
<div id="acceptance-section" class="section">
<h4> Order Confirmation </h4>
<p> We reserve the right to cancel orders arising from errors, inaccuracies, or omissions. </p>
<div id="acceptance-details" class="form form-type-001 form-style-001 validationGroup">
<div id="acceptance-terms-area">
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<label id="acceptance-terms"> I agree to the terms and conditions of the above document and PDF attachment with an electronic signature below. </label>
</div>
<!-- -->
<div class="form-label-area string-literal">
<label class="form-label"> IP Address </label>
</div>
<div class="form-input-area"> 185.213.155.153 </div>
<!-- -->
<div class="form-label-area">
<label class="form-label"> PO Number </label>
<!--<div class="form-comment">(Optional)</div>-->
</div>
<div class="form-input-area">
<input name="DH_SoldToPONumber" type="text" id="DH_SoldToPONumber" inputtype="TextBox" class="textbox">
<div class="form-comment"> (Optional: Enter PO Number as your reference only.) </div>
</div>
<!-- -->
<div class="form-label-area">
<label class="form-label"> Comments </label>
<!--<div class="form-comment">(Optional)</div>-->
</div>
<div class="form-input-area">
<textarea name="DH_AcceptanceNotes" rows="2" cols="20" id="DH_AcceptanceNotes" inputtype="TextArea" class="textarea"></textarea>
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<!-- -->
<div class="form-label-area">
<label class="form-label"> Requested Install Date: </label>
</div>
<div class="form-input-area">
<input name="DH_CustomText05" type="text" id="DH_CustomText05" inputtype="TextBox" class="required textbox">
</div>
<div class="form-label-area">
<label class="form-label"> Email Address </label>
</div>
<div class="form-input-area">
<input name="QV_InputAcceptedByEmailAddress" type="text" value="michell.griese@avera.org" id="QV_InputAcceptedByEmailAddress" class="required email textbox">
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<!-- -->
<div class="form-label-area">
<label class="form-label"> Printed Name </label>
</div>
<div class="form-input-area">
<input name="QV_InputAcceptedByName" type="text" id="QV_InputAcceptedByName" class="required textbox">
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<!------- TEXT SIGNATURE SECTION BEGIN ------->
<div class="form-label-area">
<label class="form-label"> Signature </label>
</div>
<div class="form-input-area">
<input name="QV_InputAcceptedBySignature" type="text" id="QV_InputAcceptedBySignature" class="required textbox">
<div class="form-comment"
title="You can sign the acceptance by entering any combination of alpha/numeric characters that has been specifically adopted to serve the function of your signature, preceded and followed by the forward slash (/) symbol. Acceptable signatures could include: /john smith/; /js/; or /123-4567/. No pre-approval of any particular electronic signature is required, nor must the electronic signature even be consistent from one signing to the next.">
"signatures" could include: /john smith/; /js/; /js123/, etc </div>
</div>
<!------- TEXT SIGNATURE SECTION BEGIN ------->
<!-- -->
<div class="form-label-area">
<label class="form-label">
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</div>
</div>
</div>
<!-------------------------------------- Payment Details Section -------------------------------------->
<!-------------------------------------- Questions Section -------------------------------------->
<div class="section-separator">
<div class="section-item toggle-button">
</div>
<div class="section-item"> Have Questions?</div>
</div>
<div id="questions-section" class="section">
<a name="QUESTIONS"></a>
<h4> Not Ready To Accept? Have Questions?</h4>
<div id="comment-submit-area" class="validationGroup form">
<div>
<textarea name="QV_CommentNewEntry" rows="2" cols="20" id="QV_CommentNewEntry" class="required"></textarea>
</div>
<div>
<input type="submit" name="QV_SubmitComment" value="Submit" id="QV_SubmitComment" class="causesValidation">
</div>
<p class="info-comment-001"> (Note, you will receive a copy of your message by email.) </p>
</div>
<p class="info-comment-002"> No questions posted yet. </p>
<div class="info-comment-001 time-expressed-in-message"> Time expressed in Central Daylight Time UTC-05:00 </div>
</div>
<!-------------------------------------- Footer -------------------------------------->
</div>
<div id="please-wait" class="modal-background">
<div class="modal-window" style="position: absolute; top: 570px; left: 770px;">
<div id="message"> Please Wait</div>
<img src="Images/loader003.gif">
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</form>Text Content
www.AccessSystems.com 1208 West 51st Street, Suite 1, Sioux Fallls, SD 57105 Quote ASTQ32718 Valid through June 20, 2023 @ 1:48 pm PREPARED FOR: AVERA MILBANK AREA HOSPITAL Rhonda . Phone: (605) 432-4538 301 FLYNN DRIVE MILBANK, SD 57252 michell.griese@avera.org PREPARED BY: Mike Staudenmier Sales Manager Phone: 605.338.0330 Fax: 605.338.0911 Email: Mike@tssphones.com Below is the interactive version of the quote, you can choose options and see the quote totals. For the full presentation proposal, click here to view or download the PDF version of this quote. Alternatively, you can print and scan to email to IT Orders, fax to 515-987-6228, or you can save time by simply electronically accepting this quote below. Line Item Detail QTY Description Picture Unit Price Ext Price 1 2 Plantronics CS-540 Headsets 2 Plantronics APU76 EHS Interface Cables Ship Direct to Hospital Attn: Nadean Kovarik $716.00 $716.00 SubTotal: $716.00 Shipping: $0.00 Sales Tax: $0.00 Total: $716.00 Ready to Accept? ORDER CONFIRMATION We reserve the right to cancel orders arising from errors, inaccuracies, or omissions. I agree to the terms and conditions of the above document and PDF attachment with an electronic signature below. IP Address 185.213.155.153 PO Number (Optional: Enter PO Number as your reference only.) Comments Requested Install Date: Email Address Printed Name Signature "signatures" could include: /john smith/; /js/; /js123/, etc Have Questions? NOT READY TO ACCEPT? HAVE QUESTIONS? (Note, you will receive a copy of your message by email.) No questions posted yet. Time expressed in Central Daylight Time UTC-05:00 Please Wait