NEBA Order Form

AltaPoint Software Order Form

To Order:

1. Print this page.
2. Check the items you wish to purchase.
3. Fill out the shipping information below.
4. Fax your order to (650)989-6727.
5. Your shipping charges and taxes (if applicable) will be calculated, added to your order, and your order will be faxed back to you.
6. You may then mail your check or money order with your order form to:

NEBA (National Electronic Billers Alliance)
2226-A Westborough Blvd. PMB 504
South San Francisco, CA 94080

Questions?
Phone: (650) 359-4419
Fax: (650) 989-6727
Email: merry@nebazone.com

Item

Price


	AltaPoint Single User Version	$995
	CPT, ICD-9 & HCPCS Codes (current year)	$295
	AltaPoint Network Version	$1495
	AltaPoint for Palm™ Connected Organizers	$295
	Support for single user version of AP (1 year)	$798
	Support for single user version of AP (6 months)	$399
	Shipping for software	$12
	BEST BUY FOR ALTAPOINT: NEBA members get generous discounts on the above products.* When you purchase AltaPoint Software from NEBA, you receive an excellent tips book for using the software. This is not available anywhere else as we have written and published it ourselves.

Your Information

1. Full Name

2. Date of Order

3. Title

4. Company

5. Mailing Address

6. City

7. State

8. Zip Code

9. Phone Number

10. Fax Number

11. Email Address

To be filled out by NEBA

Total Order

Shipping Charges

Tax (if appplicable)

Total Amount Due