Order Form
Client Status
Please indicate below whether you are ordering as a
new
Titanium client, ordering as a
current
Titanium client, or making a Request For Quote.
If you place an order, you will be sent an invoice within 24 hours. If you request a quote, you will be sent an estimate within 24 hours.
You must make a selection before proceeding to the other boxes below.
I am a new Titanium client placing an order
I am a current Titanium client placing an order
I am making a Request For Quote
Contact Information
Please provide us with the following information for the person we should contact about your purchase of Titanium Schedule.
Contact name:
Title:
University:
Dept/Center:
Address:
Email:
Phone:
Fax:
Order
Please check the products, optional features, and services you want to order. If you want to order multiple copies of Titanium Schedule for other departments or centers, please place each order separately.
Note: Our base product is Titanium Schedule for 5 users, and additional licenses are offered in 5-user blocks. For example, if you are ordering Titanium for a center with a staff of 14 people, you should order
Titanium Schedule for up to 5 users
and 2
Additional 5-user blocks.
Item
Order
Quantity
Price
Titanium Schedule
for up to 5 users
$1,300 first year
$1,075 per year after 1st year
Additional
5-user blocks
$200 per block first year
$40 per block per year after 1st year
Pre-pay annual
licensing fee
1
Optional (see below)
DSM-IV™ Codes
2
$175
Optional (see below)
Client Import
3
$400
Optional (see below)
Web Component
4
$100 per year
Optional (see below)
Remote Training
5
$350
Optional (see below)
Additional Information
When do you plan to install Titanium Schedule? (e.g. ASAP, this summer, next fall, etc.)
How would you like to pay (e.g. Purchase Order, Check, MasterCard/Visa)?
Please do
not
include sensitive information like credit card numbers.
Comments:
1
Pre-payment of annual licensing fee:
Payment of the annual licensing fee is not due until after the first year. However, you may pre-pay one or more years in advance if this better suits your center's budget.
Note: Since current Titanium clients may have any number of products, features, and services that may affect their annual license fee, we cannot calculate a pre-payment license amount on this web page for current Titanium clients. Current clients wishing to pre-pay should so indicate on this form, and we will directly contact you with the amount calculated specifically for your center.
2
DSM-IV™ Codes:
This feature lets you enter DSM-IV Multiaxial Evaluations using the copyrighted DSM-IV-TR codes and descriptions. (Most of the fee is sent to the APA as required by our licensing agreement with them.)
3
Client Import:
This feature allows Titanium Schedule to import client contact and demographic information from an external data source like a university registration system. Note: This feature requires that your IT support staff setup an ODBC compliant data source that can be queried by the users of Titanium. It also requires that someone use the configuration screens in Titanium to map the fields from your external data source to the appropriate fields in Titanium.
4
Web Component:
This web-based module runs in a browser on laptop or desktop computers in the center's waiting room and allows clients to enter their own intake or follow-up information directly into Titanium.
5
Remote Training:
Staff training is conducted via prearranged web-meeting. This is a casual lecture format in which our trainer will demonstrate the use of our software to your staff and answer their questions. Training sessions usually last 2 to 2.5 hours.
DSM and DSM-IV-TR are registered trademarks of the American Psychiatric Association and are used with permission herein.
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