* indicates a required field
1. *ASQ Pro is for single-site programs. Does your program have more than one site?
Yes No
2. *ASQ Pro manages both ASQ-3 and ASQ:SE (English and Spanish) questionnaire data. To use ASQ Pro, the site MUST own a print version of the corresponding questionnaires that you will be managing in the system. Does your program currently own the corresponding questionnaires which ASQ Pro will be running?
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 Pro account.
*
Email Address:
*Phone Number:
*The above contact is:
5. In addition to the annual subscription fee for ASQ Pro, you will be charged quarterly for your program’s screening usage. If you are purchasing ASQ Pro 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 Pro annual subscriptions. If you purchase ASQ Pro 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 Pro renewal fees to my credit card.
