Get the QuicFax™ Plugin

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Normal Price

$500Implementation
perlocation

Organization Name *Name of your practice or organization.
Contact Person Name of the person whom the invoices will be going to be sent to.
Organization Address *
Address of the main location if client has more than 1 clinical address.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Email *Email address of the contact person whom the invoices will be sent to.
Plugins / Modules / Services *
Check all plugins you want added.QuicFax Module
Please tell us which locations you'd like this implemented.
You can list specific locations, or tell us to implement for all your locations.
How many locations do you want activated? *You may have 50 locations, but perhaps you only want 5 locations using this plugin.
Please tell us anything here.

Terms and Conditions. *
Yes, I agree to the terms and conditions listed above.
Auto-bill Credit Card Number *
Credit Card Expiration Date *
Name on Card *
Billing Address for Credit Card *
Address that card is billed to. Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Electronic Signature *Please enter your full name above. Your IP address and computer name are being logged along with date and time stamp. This is considered your legal consent and endorsement and will be accepted as your written signature.