|
Order Form
National Center for School Based Health Information Systems
The Children’s Hospital
13123 E. 16th Avenue, B516
Aurora, CO 80045
Phone: (720) 777-8400
Fax: (720) 777-7339
| |
Shipping Address |
| Program Name: |
|
| Contact Name: |
|
| Address: |
|
| City/State/Zip: |
|
| Phone: |
|
| Fax: |
|
Please fill out either the SINGLE COPY ORDER table or the NETWORK
COPY ORDER table. Refer to SOFTWARE
PRICING INFORMATION to assist you in filling out the order form.
Remember that discounts are available only for the software, not for the
maintenance fee or the networking fees.
Make the check payable to: The Children's Hospital
Federal Tax ID: 84-0166760
|
Single Copy Order |
|
|
|
| Description |
Quantity |
Price Each |
Total Price |
| Clinical Fusion™ Software |
|
$750.00 |
|
| Discount (if applicable) |
|
|
|
| Software Subtotal |
|
|
|
| Annual Maintenance Fee |
|
$250.00 |
|
| Spell Checker |
|
$75.00 |
|
| Scheduling Module |
|
$75.00 |
|
| Subtotal |
|
|
|
| Shipping and Handling |
|
$15.00 |
|
| GRAND TOTAL |
|
|
|
|
Network Copy Order |
|
|
|
| Description |
Quantity |
Price Each |
Total Price |
Clinical Fusion™ Software
(Waived if Existing SHO User) |
|
$750.00 |
|
| Discount (if applicable) |
|
|
|
| Software Subtotal |
|
|
|
| Annual Maintenance Fee |
|
$250.00 |
|
|
Network Software Fee |
|
$250.00
(per workstation) |
|
| Network Maintenance Fee |
|
$55.00
(per workstation) |
|
| Spell Checker |
|
$75.00 + $35 per
workstation |
|
| Scheduling Module |
|
$75.00 + $35 per
workstation |
|
| Subtotal |
|
|
|
| Shipping and Handling |
|
$15.00 |
|
| GRAND TOTAL |
|
|
|
Home Overview What's New Software Features Screen Shots Technical Assistance Downloads and Updates Online Tutorial Order Software Contents
| 