QTF Custom Keyguard Request

Please complete the following form for each Custom Keyguard you would like for your QuickTalker Freestyle

Please provide accurate contact information so we can ensure you receive the keyguard.
Reference No.*
FN######
Speech-Language Pathologist Requesting Keyguard
First Name*
Last Name*
Mobile Phone Number*
SMS Checkmark - hidden

Yes
Email*
Best way to reach you*
I am a*
I work at a*
Ship-To Information
Company / School / Clinic Name:
Attention to*

First NameLast Name
Address*
Address
Address 1
Address 2
City
State
Zip Code
Keyguard Information
Who is the keyguard for?*

Client First NameClient Last Name
Family Contact / Legal Guardian email*
example@example.com
Is this keyguard for your ableEXPERIENCE device?*
iPad Size*
Keyguard Color*
How many of this keyguard layout will you need?*
Does your case have integrated keyguard holes on the left and right sides of the screen AND have two QR codes on the kickstand?*
Select AAC app*
Touchchat w/ Wordpower Layout Sub-Category and Name*
TD Snap Layout Sub-Category and Name*
LAMP Words for Life Layout Name*
Proloquo2Go Sub-Category and Layout Name*
Integrated Touchchat w/ Wordpower Layout Sub-Category and Name*
Integrated TD Snap Layout Sub-Category and Name*
Integrated Proloquo2Go Sub-Category and Layout Name*
Integrated LAMP Words for Life Layout Name*
Keyguard Preview
Integrated LAMP
TouchChat
TD Snap
Integrated Proloquo2Go
10.9 Cough Drop
10.9 GoTalk Now
10.9 Grid for Ipad
10.9 LAMP
10.9 Proloquo2Go
10.9 Speak For Yourself
10.9 TD Snap
10.9 TouchChat
Would you like the keyguard as shown or would you like to make alterations?*

Looks Good! Please create that keyguard.I would like to make changes.
Please Note- By Acknowledging, you understand that ableCARE will not be in contact with you and your keyguard will be automatically shipped out.*

I Acknowledge
File Name (old)
Other app name
App Layout (e.g. WordPower 60, MultiChat 15, grid size 7x11, etc.)*
Do you have physical access to the device to obtain a screenshot of the app layout?*
Upload a screen shot of the requested keyguard.

Although this information is optional, uploading a screenshot is helpful to ensure we have the proper information.
Cancelof
What would you like to change on this keyguard request?*

0/255
Additional comments

0/255
File Name
By clicking Submit, you agree to our Privacy Policy & Terms of Use
Please verify that you are human*
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Please complete the following form for each Custom Keyguard you would like for your QuickTalker Freestyle

Speech-Language Pathologist Requesting Keyguard

Ship-To Information

Keyguard Information

Keyguard Preview

Integrated LAMP

TouchChat

TD Snap

Integrated Proloquo2Go

10.9 Cough Drop

10.9 GoTalk Now

10.9 Grid for Ipad

10.9 LAMP

10.9 Proloquo2Go

10.9 Speak For Yourself

10.9 TD Snap

10.9 TouchChat