If you need a James for your aged care facility, please fill in the form...
Email address *
Name of the facility *
How many James would you need? *
Does the facility has the wifi? *
If you have Wifi, please help us to set everything up by providing us the SSID and password (these datas will remain confidential. We suggest you to simply change them once the crisis is over)
Please tell us who is the person in charge of the Wifi + cell phone contacts... *
Please tell us how many floors and rooms has the building? *
Please give us a person of contact *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy