ParTech DataBasic and DataBasic Enhanced Order Form

NH ParTech's mission focuses on the use of automation to improve the efficiency and productivity of those that serve the uninsured and underinsured within the State of New Hampshire. NH ParTech now offers an opportunity for health and human service agencies, through the use of ParTech DataBasic, to take an important step into realizing the benefits of a simple to use and cost effective automation tool.

Upon placement of this order, you will be invoiced for the one-time License Fee and first year maintenance for the product variant of your choice, per the ParTech Connection Price List. Each user will receive a secure login with the ability to enter data that records and allows easy access to client information.

Interested Agencies must fill out the following order form and acknowledge their acceptance of the terms of the License Agreement:

Link to the ParTech DataBasic End User License Agreement

Product: Enter "Basic" or "Enhanced":

Agency Name:

Your Name:

Your Title:

Email Address:

Street:

New Hampshire City:

Telephone Number:

Zip Code:

I am authorized to place this order behalf of the above agency:
Yes

I have read and accept the terms of the ParTech DataBasic License Agreement:
Accept

Please include the names of users (first and last) and describe your current internet service (dial-up, DSL, Cable, Other):