ASQ Online Annual Subscription Account Setup | Brookes Publishing Co.

ASQ Online Annual Subscription Account Setup

Please fill out the following form completely. All requested information must be supplied before we can set up your ASQ Online annual subscription.

NOTE: You must have a pending ASQ Online Annual Subscription order number to complete this form.

ASQ Online Order Info

ASQ Online Order Number (e.g. Purchase Order, Web Confirmation, Invoice)**
ASQ Online Annual Subscription Service Requested*
- Subscription Service
  - ASQ Pro (single-site service) $149.95 annually
  - ASQ Enterprise (multi-site service) $499.95 annually

Account / Program Details

Program Country*
- Country
  - United States
  - Canada
  - Afghanistan
  - Åland Islands
  - Albania
  - Algeria
  - American Samoa
  - Andorra
  - Angola
  - Anguilla
  - Antarctica
  - Antigua and Barbuda
  - Argentina
  - Armenia
  - Aruba
  - Australia
  - Austria
  - Azerbaijan
  - Bahamas
  - Bahrain
  - Bangladesh
  - Barbados
  - Belarus
  - Belgium
  - Belize
  - Benin
  - Bermuda
  - Bhutan
  - Bolivia
  - Bonaire, Sint Eustatius and Saba
  - Bosnia and Herzegovina
  - Botswana
  - Bouvet Island
  - Brazil
  - British Indian Ocean Territory
  - Brunei Darrussalam
  - Bulgaria
  - Burkina Faso
  - Burundi
  - Cambodia
  - Cameroon
  - Cape Verde
  - Cayman Islands
  - Central African Republic
  - Chad
  - Chile
  - China
  - Christmas Island
  - Cocos Islands
  - Colombia
  - Comoros
  - Congo, Democratic Republic of the
  - Congo, Republic of the
  - Cook Islands
  - Costa Rica
  - Côte d'Ivoire
  - Croatia
  - Cuba
  - Curaçao
  - Cyprus
  - Czech Republic
  - Denmark
  - Djibouti
  - Dominica
  - Dominican Republic
  - Ecuador
  - Egypt
  - El Salvador
  - Equatorial Guinea
  - Eritrea
  - Estonia
  - Eswatini (Swaziland)
  - Ethiopia
  - Falkland Islands
  - Faroe Islands
  - Fiji
  - Finland
  - France
  - French Guiana
  - French Polynesia
  - French Southern Territories
  - Gabon
  - Gambia
  - Georgia
  - Germany
  - Ghana
  - Gibraltar
  - Greece
  - Greenland
  - Grenada
  - Guadeloupe
  - Guam
  - Guatemala
  - Guernsey
  - Guinea
  - Guinea-Bissau
  - Guyana
  - Haiti
  - Heard and McDonald Islands
  - Holy See
  - Honduras
  - Hong Kong
  - Hungary
  - Iceland
  - India
  - Indonesia
  - Iran
  - Iraq
  - Ireland
  - Isle of Man
  - Israel
  - Italy
  - Jamaica
  - Japan
  - Jersey
  - Jordan
  - Kazakhstan
  - Kenya
  - Kiribati
  - Kuwait
  - Kyrgyzstan
  - Lao People's Democratic Republic
  - Latvia
  - Lebanon
  - Lesotho
  - Liberia
  - Libya
  - Liechtenstein
  - Lithuania
  - Luxembourg
  - Macau
  - Macedonia
  - Madagascar
  - Malawi
  - Malaysia
  - Maldives
  - Mali
  - Malta
  - Marshall Islands
  - Martinique
  - Mauritania
  - Mauritius
  - Mayotte
  - Mexico
  - Micronesia
  - Moldova
  - Monaco
  - Mongolia
  - Montenegro
  - Montserrat
  - Morocco
  - Mozambique
  - Myanmar
  - Namibia
  - Nauru
  - Nepal
  - Netherlands
  - New Caledonia
  - New Zealand
  - Nicaragua
  - Niger
  - Nigeria
  - Niue
  - Norfolk Island
  - North Korea
  - Northern Mariana Islands
  - Norway
  - Oman
  - Pakistan
  - Palau
  - Palestine, State of
  - Panama
  - Papua New Guinea
  - Paraguay
  - Peru
  - Philippines
  - Pitcairn
  - Poland
  - Portugal
  - Puerto Rico
  - Qatar
  - Réunion
  - Romania
  - Russia
  - Rwanda
  - Saint Barthélemy
  - Saint Helena
  - Saint Kitts and Nevis
  - Saint Lucia
  - Saint Martin
  - Saint Pierre and Miquelon
  - Saint Vincent and the Grenadines
  - Samoa
  - San Marino
  - Sao Tome and Principe
  - Saudi Arabia
  - Senegal
  - Serbia
  - Seychelles
  - Sierra Leone
  - Singapore
  - Sint Maarten
  - Slovakia
  - Slovenia
  - Solomon Islands
  - Somalia
  - South Africa
  - South Georgia
  - South Korea
  - South Sudan
  - Spain
  - Sri Lanka
  - Sudan
  - Suriname
  - Svalbard and Jan Mayen Islands
  - Sweden
  - Switzerland
  - Syria
  - Taiwan
  - Tajikistan
  - Tanzania
  - Thailand
  - Timor-Leste
  - Togo
  - Tokelau
  - Tonga
  - Trinidad and Tobago
  - Tunisia
  - Turkey
  - Turkmenistan
  - Turks and Caicos Islands
  - Tuvalu
  - Uganda
  - Ukraine
  - United Arab Emirates
  - United Kingdom
  - Uruguay
  - US Minor Outlying Islands
  - Uzbekistan
  - Vanuatu
  - Venezuela
  - Vietnam
  - Virgin Islands, British
  - Virgin Islands, U.S.
  - Wallis and Futuna
  - Western Sahara
  - Yemen
  - Zambia
  - Zimbabwe
Program Name*
Program Address Line 1*
Program Address Line 2
Program City*
Program State*
- State
  - Alabama
  - Alaska
  - Arizona
  - Arkansas
  - California
  - Colorado
  - Connecticut
  - Delaware
  - District of Columbia
  - Florida
  - Georgia
  - Hawaii
  - Idaho
  - Illinois
  - Indiana
  - Iowa
  - Kansas
  - Kentucky
  - Louisiana
  - Maine
  - Maryland
  - Massachusetts
  - Michigan
  - Minnesota
  - Mississippi
  - Missouri
  - Montana
  - Nebraska
  - Nevada
  - New Hampshire
  - New Jersey
  - New Mexico
  - New York
  - North Carolina
  - North Dakota
  - Ohio
  - Oklahoma
  - Oregon
  - Pennsylvania
  - Rhode Island
  - South Carolina
  - South Dakota
  - Tennessee
  - Texas
  - Utah
  - Vermont
  - Virginia
  - Washington
  - West Virginia
  - Wisconsin
  - Wyoming
  - Armed Forces Americas
  - Armed Forces Europe
  - Armed Forces Pacific
Program Province*
- Province
  - Alberta
  - British Columbia
  - Manitoba
  - New Brunswick
  - Newfoundland & Labrador
  - Northwest Territories
  - Nova Scotia
  - Nunavut
  - Ontario
  - Prince Edward Island
  - Quebec
  - Saskatchewan
  - Yukon
Program State (Intl.)*
Program Zip/Postal Code*
Program Phone Number*
Program Phone Number*

Subscription Administrator Details

The Subscription Account Administrator designated below will be the individual to receive the initial welcome/login email to set up your program’s ASQ Online annual subscription. This person can set up other users and designate roles (including other Account Administrators), as well as set up program information, and child profiles, etc.

Subscription Administrator Name*
Subscription Administrator Phone*
Subscription Administrator Phone*
Email*

Choose Your Subscription Start Date!

ASQ Online annual subscriptions may only start on the 1st, 5th, 10th, 15th, 20th, or 25th of any given month. If you select a start date that falls on a weekend or holiday, access will be granted the following business day. Same day startups are not possible. Please select an applicable FUTURE start date for your subscription.

Subscription Start Date*
- Month
  - January
  - February
  - March
  - April
  - May
  - June
  - July
  - August
  - September
  - October
  - November
  - December
Subscription Start Date Jan*
- Date
  - 5th
  - 10th
  - 15th
  - 20th
  - 25th
Subscription Start Date Dec*
- Date
  - 1st
  - 5th
  - 10th
  - 15th
  - 20th
Subscription Start Date*
- Date
  - 1st
  - 5th
  - 10th
  - 15th
  - 20th
  - 25th

Terms and Conditions

By checking here and submitting this form, I certify that I understand:*
- A unique ASQ keycode for EACH set of Questionnaires, and for each physical site, is required to access those Questionnaires in my ASQ Online Subscription. e.g. If I wish to screen using ASQ-3 English Questionnaires at one physical site and with ASQ:SE-2 Spanish Questionnaires at two physical sites, I will need one ASQ-3 English Keycode and two ASQ:SE-2 Spanish Keycodes. These keycodes are only located inside the physical set of applicable ASQ Questionnaires (separate purchase is required for all necessary physical print product/keycodes).
By checking here and submitting this form, I certify that:*
- I own all of the required physical ASQ Questionnaires required for my ASQ Online subscription.
By checking here and submitting this form, I certify that I understand:*
- ASQ Online is an “opt-out” subscription, meaning this subscription will automatically renew each year unless the customer informs vendor (Brookes Publishing) of intent to cancel prior to the start of a new subscription year. ASQ Online Annual Subscription fees are invoiced each year in advance and are payable prior to your subscription renewal date. Customers will receive a renewal invoice notice via USPS mail approximately 90-days prior to the end of the annual subscription period.
By checking here and submitting this form, I certify that I understand:*
- ASQ Screens are billed annually in arrears based on actual screen usage at the end of the subscription year. The annual screening usage statement may vary and will be billed according to the actual number of screens used at $0.50 for each Screen completed. This usage fee is separate, and above and beyond, the annual subscription service fee.
Electronic Signature and Job Title*

Please type your name and job title. Typing your name here constitutes your signature and agreement to begin your annual ASQ Online subscription with the details provided herein and subject to the Terms & Conditions.

Comments and Questions

Do you have any additional comments or info you’d like to share?