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Billing Information

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Payment Details

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Contact Name:
Contact Tel No:
Contact Email:

Purchase Date: November 21, 2020

Billing Cycle: Monthly

Name on Card:

Credit Card:

Type Description QNTY Unit Price Amount
Base Package (HIPAA, 3 users) 1 $99.00 $99.00
Estimated Users 3 included in base price 1 $0.00 $0.00
Assessments 2 $0.00 $0.00
BA Module BA Management (+10) 1 $0.00 $0.00
Vendor Module Vendor Management 1 $59.00 $59.00
Sub-Total $0.00
$0.00
Discount -$0.00
Total Due

$0.00