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Application for mimio Education Pricing
(for Education Institutions in Australia only)

To apply online, please complete the form below and press "Submit". After selecting "Submit", you will have the option of printing a copy of your submission for your records. Note: fields marked with an asterisk (*) below are required information.

School Information
*School:

  School District:

*Address 1:

  Address 2:

*City:

*State:

*Postal Code:

*Country:


Contact Information
*First Name:

*Last Name:

  Title:

*Email:

*Phone:


Authorized mimio Reseller Information
*Authorized Reseller Name:

*Address:

*City:

*State:

*Postal Code:

*Country:

  Contact Name:

  Email:

  Phone:


To locate a local authorized reseller, please check the listings for Australia at http://www.mimio.com/buy/resellers.php or email info@mimio.com

*Please tell us how you heard about mimio
products:

*Products:
Please check the product(s) you are interested in purchasing and enter quantity.

Products:		Quantity:
mimio Interactive
mimio Interactive + Capture
mimio Xi Classic Trade-in Kit

Accessories for mimio Interactive:
mimio Wireless Upgrade Kit
mimio Carry Case
Additional mounting brackets (3M)
	1 pack
	5 pack
Additional mounting brackets (magnetic)
	1 pack
	5 pack

Accessories for all products:
mimioMouse Interactive Stylus Pen

*Operating System:
     Windows
     Macintosh
     Both (Win/Mac)

*Expected Purchase Date:
     less than 30 days
     31 - 60 days
     61 - 90 days
     90+ days

Statement of Terms
Please read the following statement before submitting and agree to its terms.

I represent that this application has been written solely by me and not copied by any other source or person. I understand that mimio may use the described plan for integration of mimio in my classroom in any manner it desires with no compensation and obligation of confidentiality to me. mimio shall not be liable for any use or disclosure of my mimio Grant pricing submission by me.

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