MEDx New License Request Form

Use this form only if you have purchased a copy of MEDx and are requesting a new Permanent License. Just fill in all the fields below with your name, contact, system, and host information. The fields marked with a '*' are required. You will receive an immediate response (via e-mail) confirming our receipt of your information. We will then send you your new MX License Number and new Permanent License key.

(NOTE: If you are a user at the US National Institutes of Health, please use the URL http://www-medx.cc.nih.gov/MEDX_WWW/MEDxlocal_reg_form.html to download and install MEDx.)

Please see the license agreement and the medical usage restrictions for details of limitations that apply to the use of MEDx.

Last Name*
First Name*
E-mail address*
Voice Number
Fax Number
Organization*
Street Address
City*
State*
Postal Code*
Country*
UNIX Platform
UNIX OS (e.g. Solaris 2.5)
Physical Memory (RAM in MB)
Swap Space (in MB)
Medical Scanners in use at your site
Host Name*
Host ID*
License Type (usually host)
Purchase Order or Quotation Number


	Copyright © 2004 Medical Numerics, Inc. All Rights Reserved Last Modified on Tuesday, October 9, 2007 Home \| MEDx Home \| Legal