InCenter Access Form

Customers with existing Support Agreements, please complete the following information to obtain access to InCenter.
* Indicates required field.


* First Name
*Last Name
*Email Again


1. Please supply either your serial number and/or product equipment number and/or support agreement contract number. Please contact your local Philips Sales Representative if you cannot locate one of these numbers.

2. Start Date:

3. End Date:

4. Type of Equipment Covered
Patient Monitoring
Clinical Informatics
IntelliSpace Event Management
Diagnostic ECG

5. Number of site users determined by total contract value as follows
less than 10K = 1 user
more than 10K but less than 25K = 2 users
more than 25K but less than 100K= 5 users
more than 100K = unlimited
1 user
2 users
5 users

6. User1 first name

7. User1 last name

8. User1 e-mail

9. User1 telephone

10. User2 first name

11. User2 last name

12. User2 e-mail

13. User2 telephone

14. User3 first name

15. User3 last name

16. User3 e-mail

17. User3 telephone

18. User4 first name

19. User4 last name

20. User4 e-mail

21. User4 telephone

22. User5 first name

23. User5 last name

24. User5 e-mail

25. User5 telephone