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onmouseover="MM_showHideLayers('layercompany','','hide','layerproducts','','hide','layerpartners','','hide','layersupport','','hide','layercontact','','hide')"><img src="../images/home/home_01.gif" alt="" width="750" height="103" border="0"></a></td> </tr> <tr> <td class="bottomborder"><a href="#" onmouseover= "MM_showHideLayers('layercompany','','show','layerproducts','','hide','layerpartners','','hide','layersupport','','hide','layercontact','','hide','companytext','','show','productstext','','hide','partnerstext','','hide','supporttext','','hide','contacttext','','hide')"> <img src="../images/home/company.gif" alt="" name="company" width="100" height="16" border="0"></a></td> <td class="bottomborder"><a href="#" onmouseover= "MM_showHideLayers('layercompany','','hide','layerproducts','','show','layerpartners','','hide','layersupport','','hide','layercontact','','hide','companytext','','hide','productstext','','show','partnerstext','','hide','supporttext','','hide','contacttext','','hide')"> <img src="../images/home/products.gif" alt="" name="products" width="100" height="16" border="0"></a></td> <td class="bottomborder"><a href="#" onmouseover= "MM_showHideLayers('layercompany','','hide','layerproducts','','hide','layerpartners','','show','layersupport','','hide','layercontact','','hide','companytext','','hide','productstext','','hide','partnerstext','','show','supporttext','','hide','contacttext','','hide')"> <img src="../images/home/partners.gif" alt="" name="partners" width="100" height="16" border="0"></a></td> <td class="bottomborder"><a href="#" onmouseover= "MM_showHideLayers('layercompany','','hide','layerproducts','','hide','layerpartners','','hide','layersupport','','show','layercontact','','hide','companytext','','hide','productstext','','hide','partnerstext','','hide','supporttext','','show','contacttext','','hide')"> <img src="../images/home/support.gif" alt="" name="support" width="100" height="16" border="0"></a></td> <td class="bottomborder"><a href="#" onmouseover= "MM_showHideLayers('layercompany','','hide','layerproducts','','hide','layerpartners','','hide','layersupport','','hide','layercontact','','show','companytext','','hide','productstext','','hide','partnerstext','','hide','supporttext','','hide','contacttext','','show')"> <img src="../images/home/contact.gif" alt="" name="contact" width="100" height="16" border="0"></a></td> <td class="bottomborder"><a href="../index.html" onmouseover= "MM_showHideLayers('layercompany','','hide','layerproducts','','hide','layerpartners','','hide','layersupport','','hide','layercontact','','hide');MM_swapImage('home','','../images/home/home-over.gif',1)" onmouseout= "MM_swapImgRestore()"><img src="../images/home/home.gif" alt="" name="home" width="100" height="16" border="0" id="home"></a><img src="../images/home/home_07.gif" width="150" height="16" alt=""></td> </tr> </table> </td> </tr> <tr> <td valign="top"> <table width="750" height="100%" border="0" cellpadding="20" cellspacing="0"> <tr> <td width="500" valign="top">  <p class="header">Become a Medfx Corp Certified Business Partner</p> <p style="margin-top: 0;" Medfx Corp is currently recruiting qualified medical solution resellers and integrators to be certified business partners for its practice management software called MEDfx.<br> "The healthcare community has never seen anything like MEDfx before," said Gerald T. Barry, CEO. "This new product will change the way doctors, clinics, and practices can do business. We need a strong national presence of qualified partners to reach clinicians with the news of this revolutionary product."</p> <p>Interested resellers are invited to fill out the application below and submit it to GBA. Free demonstrations of the product are also available.</p> <form action="certifiedpartner.php" method="post"> <table border="0" cellspacing="0" cellpadding="0"> <tr> <td colspan="2" align="left" class="formcell"> <p class="subhead">Certified Business Partner Application</p> </td> </tr> <tr> <td class="formcell"> <p>Your Name:<font color="#CC0033">*</font></p> </td> <td class="formcell"><input name="name" type="text" value=""></td> </tr> <tr> <td class="formcell">Your Title:</td> <td class="formcell"><input name="title" type="text" id="title" value=""></td> </tr> <tr> <td class="formcell"> <p>Company Name:<font color="#CC0033">*</font></p> </td> <td class="formcell"><input name="company" type="text" id="company" value=""></td> </tr> <tr> <td class="formcell"> <p>Address:<font color="#CC0033">*</font></p> </td> <td class="formcell"><input name="address" type="text" value=""></td> </tr> <tr> <td class="formcell"> <p>City:<font color="#CC0033">*</font></p> </td> <td class="formcell"><input name="city" type="text" value=""></td> </tr> <tr> <td></td> </tr> <tr> <td class="formcell"> <p>State:<font color="#CC0033">*</font></p> </td> <td class="formcell"><select input="" name="state" id="state"> <option value="1"> Please Select </option> <option value="AL"> Alabama </option> <option value="AK"> Alaska </option> <option value="AZ"> Arizona </option> <option value="AR"> Arkansas </option> <option value="CA"> California </option> <option value="CO"> Colorado </option> <option value="CT"> Connecticut </option> <option value="DE"> Delaware </option> <option value="DC"> Dist of Columbia </option> <option value="FL"> Florida </option> <option value="GA"> Georgia </option> <option value="HI"> Hawaii </option> <option value="ID"> Idaho </option> <option value="IL"> Illinois </option> <option value="IN"> Indiana </option> <option value="IA"> Iowa </option> <option value="KS"> Kansas </option> <option value="KY"> Kentucky </option> <option value="LA"> Louisiana </option> <option value="ME"> Maine </option> <option value="MD"> Maryland </option> <option value="MA"> Massachusetts </option> <option value="MI"> Michigan </option> <option value="MN"> Minnesota </option> <option value="MS"> Mississippi </option> <option value="MO"> Missouri </option> <option value="MT"> Montana </option> <option value="NE"> Nebraska </option> <option value="NV"> Nevada </option> <option value="NH"> New Hampshire </option> <option value="NJ"> New Jersey </option> <option value="NM"> New Mexico </option> <option value="NY"> New York </option> <option value="NC"> North Carolina </option> <option value="ND"> North Dakota </option> <option value="OH"> Ohio </option> <option value="OK"> Oklahoma </option> <option value="OR"> Oregon </option> <option value="PA"> Pennsylvania </option> <option value="RI"> Rhode Island </option> <option value="SC"> South Carolina </option> <option value="SD"> South Dakota </option> <option value="TN"> Tennessee </option> <option value="TX"> Texas </option> <option value="UT"> Utah </option> <option value="VT"> Vermont </option> <option value="VA"> Virginia </option> <option value="WA"> Washington </option> <option value="WV"> West Virginia </option> <option value="WI"> Wisconsin </option> <option value="WY"> Wyoming </option> </select></td> </tr> <tr> <td class="formcell"> <p>Zip:<font color="#CC0033">*</font></p> </td> <td class="formcell"><input name="zip" type="text" value="" input="" title="Example #####"></td> </tr> <tr> <td class="formcell"> <p>Your Specialty:</p> </td> <td class="formcell"><input name="specialty" type="text" value=""></td> </tr> <tr> <td></td> </tr> <tr> <td class="formcell"> <p>Your Specialty:</p> </td> <td class="formcell"><input name="specialty" type="text" value=""></td> </tr> <tr> <td class="formcell"> <p>Telephone No.:<font color="#CC0033">*</font></p> </td> <td class="formcell"><input name="phone" type="text" value=""></td> </tr> <tr> <td class="formcell"> <p>Fax No.:<br></p> </td> <td class="formcell"><input name="fax" type="text" value=""></td> </tr> <tr> <td class="formcell"> <p>Email Address:<font color="#CC0033">*</font></p> </td> <td class="formcell"><input name="email" type="text" value=""></td> </tr> <tr> <td class="formcell">URL:</td> <td class="formcell"><input type="text" name="url" value=""></td> </tr> <tr> <td class="formcell">Primary Line of Business:</td> <td class="formcell"><input type="text" name="primary_line_of_business" value=""></td> </tr> <tr> <td class="formcell">Number of Employees:</td> <td class="formcell"><input type="text" name="number_of_employees" value=""></td> </tr> <tr> <td class="formcell">Number of Customers:</td> <td class="formcell"><input type="text" name="number_of_customers" value=""></td> </tr> <tr> <td class="formcell">Number of Customers using Practice Management Software:</td> <td class="formcell"><input type="text" name="number_of_customers_using_practice_mgt_software" value=""></td> </tr> <tr> <td class="formcell">Number of Customers in Medical Field:</td> <td class="formcell"><input type="text" name="number_of_customers_in_medical_field" value=""></td> </tr> <tr> <td class="formcell">What Medical Software do you sell?</td> <td class="formcell"><input type="text" name="what_medical_software_do_you_sell" value=""></td> </tr> <tr> <td class="formcell">What Practice Management software do you resell?<br></td> <td class="formcell"><input type="text" name="what_practice_management_software_do_you_resell" value=""></td> </tr> <tr> <td class="formcell">Does your company offer Technical Support?<br> <br></td> <td class="formcell"><input type="text" name="does_your_company_offer_technical_support" value=""></td> </tr> <tr> <td class="formcell">To what area of the U.S. does your company sell?</td> <td class="formcell"><input type="text" name="to_what_area_of_the_US_does_your_company_sell" value=""></td> </tr> <tr valign="top"> <td colspan="2" class="formcell">List all other hardware and software products your company resells/supports:<br> <textarea name="hardware_software_company_supports_or_resells" cols="40" rows="4" value=""> </textarea><br></td> </tr> <tr> <td colspan="2" class="formcell">Why do you want to resell MEDfx?<br> <textarea name="why_do_you_want_to_resell_medfx" cols="40" rows="4" value=""> </textarea></td> </tr> <tr> <td class="formcell"> </td> <td class="formcell"><input type="submit" value="Submit"></td> </tr> </table> </form> <p> </p><img src="../images/spacer.gif" width="460" height="2"> </td> <td width="250" valign="top" background="../images/home/background.jpg" class="insideright">  <table border="0" cellspacing="0" cellpadding="5"> <tr> <td> <p class="header"><img src="../images/home/medfxlogo-fcw.gif" width="150" height="99"></p> <p>Contact:<br> <strong>Mark Norris</strong><br> Business Partner Sales Manager<br> 800-421-9497<br> <a href="mailto:info@gbahn.com">info@gbahn.com</a></p> <p class="header"> </p> </td> </tr> </table><img src="../images/spacer.gif" width="210" height="2"> </td> </tr> </table> </td> </tr> <tr> <td height="20" align="center" class="insidefooter"><img src="../images/address.gif" width="486" height="16" border="0" usemap="#Map"></td> </tr> </table><map name="Map"> <area shape="rect" coords="381,2,479,15" href="mailto:info@gbahn.com"> </map> <script type="text/javascript" language="javascript"> llactid=14582 </script><script type="text/javascript" language="javascript" src="http://t4.trackalyzer.com/trackalyze.js"> </script> </body> </html>