Dear Potential Reseller, I would like to personally thank you for visiting the Healthpac Computer System website’s reseller section. I am very excited to share with you, the opportunity to resell our medical billing and practice management software. Healthpac has a very comprehensive commission plan. We are looking for resellers that are honest and have integrity. Previous medical software sales are very important and excellent customer service is a must! Our resellers must be excellent communicators and believe in our product as much as we do. You will see why Healthpac is one of the leading developers of medical billing software in the country. We have been developed by practice managers, billing company owners and physicians. Please complete the attached form and our Marketing Director will be in touch with you to talk to you about the Healthpac program and to arrange an internet demo of our billing solution. We look forward to sharing our vision with you and speaking with you soon. Sincerely, B. D. Claborn, Jr. President - Please note that all asterisked (*) fields are required.

First Name : * Last Name * Company Name * Title/Position Specialty Address Line 1 Address Line 2 City State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon ZIP / Postal Code Email Address* Phone Number* (area code-phone number-ext.) Fax How long has your organization been in business? How many employees do you have? What medical software(s) do you currently sell? To what area(s) of the US dows you currently sell? How long has your company been selling medical software? What is the average number of physicians in an organization to which you sell? What is the average number of locations in an organization to which you sell? Please mention top five competitors in your area that sell practice management software How did you hear about Healthpac? Email Newsletter Magazine Ad Mailer Referral Conference Web Search [Other] Please feel free to provide any other comments