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Demo / Quote Request Form
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We would like to help you with your questions about SNAP Health Center. Please fill the form below to request a live web demonstration and or request a quote. A PSNI representative will contact you soon to schedule a live demo and/or provide a quote and answer any questions you may have. Fields marked with a red * are required.

First Name: *
Last Name: *
E-mail Address: *
Position: *
Phone #: *
School Name: *
Address 1:
Address 2:
City: *
State: *
ZIP:
Country:
Contact method: *
Phone Email


If you'd a like a quote then please fill out the following information
# Schools:
# Simultaneous Users:
District Student Information System (SIS)
If more than 1 school
  Will it be installed on a district, or central,
server (i.e. networked):
Yes No
Expected date of purchase:
Would you like additional information
about any of the following:
Medicaid Billing Link
Health Portal for Parents and Staff
Additional Comments / Suggestions:
How did you hear about us? *
Word of Mouth
Conference
Web Banner
Internet Search
Twitter
Facebook
LinkedIn
PowerSchool
Rediker
MMS
Excent Medicaid
NASN Advertisement
Other
   
         


Site last modified: Nov. 20, 2009
Please contact us with any questions or comments.
Email: sales@promedsoftware.com
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