Provider Services, Inc.

PSI-Lytec 2009 Order Form

 

Practice Name: ___                             ________          Phone (      ) ______                 ____ _

Practice Type/Specialty: ____________________         Fax (      ) ______                           ____

Contact Name: ________                                                    Payment Method: Check# __________            ___    

Address: ______                                                      ___       Circle One:  VISA / MasterCard 

City, State, Zip: __                                                                  Credit Card #: __________________   __ ___

Previous Serial #: _________________________         Exp. Date: ____________Code_                       

Order Date: _______                                                            Signature: _____________________ ______

 

    Lytec 2009                   New Price     from 2008   from 2007                   Total Price

2009 Single-User                     $2,995.00      $   875.00       $2,545.00             $ _____________

2009 Multi-User                        $3,795.00     $1,095.00     $3,225.00             $ _____________

2009 Professional                   $4,295.00      $1,245.00     $3,655.00             $ _____________

2009 Client Server 5-User      $4,895.00      $1,425.00      $4,165.00             $ _____________

2009 Client Server 10-User     $6,395.00      $1,855.00      $5,435.00             $ _____________

2009 Client Server 20-User   $11,095.00                $3,225.00      $9,435.00             $ _____________

Lytec CS 5 user Add-on pack $ 2,395.00     $   695.00                                      $ _____________

 

We have your current version of Lytec as:                                                                     

Discount by Lytec                                         $ _____________

Discount if PSI is your Gateway Vendor        $ _____________

 

(All Discounts expire on 12/29/2008)

 

Additional Products and Services:                                                         

Technical Support

            One Year Support (unlimited user)                           $999.00                 $ _____________

            Monthly Support                                                           $249.00                 $ _____________

 

On Site Visits

            Hourly Training/Problem Resolution:      # of Hours ___ X  $90.00   $ _____________

 

Training Seminars

            Approx. 2 times a year.(Call for next seminar dates) $159.00              $ _____________

 

ERA’s

            Lytec Electronic Claim/ERA (Gateway EDI)            $249.00                 $ _____________

EMR’s

            Communication Manager                                                  $1,395.00              $ _____________

            Lytec MD (Per Provider-Includes 5 users)          $6,775.00               $ _____________

            Lytec MD–Annual Maintenance(Required w/ MD)$1,425.00              $ _____________

                                                                                                            Subtotal        $ _____________

All sales are final                                                                     Sales Tax (6.3%)     $ _____________

                                                                                        Shipping & Handling     $ _____________

1-2 Hours of FREE Installation/Training with NEW Order           

                                                                                    TOTAL DUE                   $ _____________

Mail Check & Make Check Payable to:                    

 

Provider Services, Inc.,

 

25493 Kansas Ave, Tonganoxie, KS66086    (913) 369-3886 or fax (913) 369-3887