RCM VENDORS CONTRACT FORM

If you feel that your company maintains a steadfast commitment to policies and procedures that adhere to our Standards of Excellence, and wish to advertise with us, please fill in, electronically sign and submit the Vendors Contract Form below.

Electronically signing and submitting our Vendors Contract Form constitutes a legal and binding agreement between Really Care Management and the Company named on that specific Vendors Contract Form.

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Your Company Information

Company Name	Contact Name

Street Address	Contact E-Mail

City, State, Zip	Contact Phone

Type of Business	Best Time to Reach you by Phone?

Size of Business Very Small Business ~ 1-25 Employees Small Company ~ 26-100 Employees Mid-Sized Company ~ 101-500 Employees Large Company ~ 501-1000 Employees Corporation ~ 1001 + Employees	Time Zone Pacific Time Mountain Time Central Time Eastern Time Atlantic Time

Website Name	Site URL

Do you presently have a Logo? Yes No	If not, would you like us to design one for you? Yes No

Type Your Ad Here




Electronic Signature

Your signature below serves as legal acceptance of this contract for Web Marketing Services, in the category of Vendor, as detailed on RCM's Vendor - List page. This Advertising Opportunity is provided by Really Care Management on our website located at http://www.rcare.com, and is exclusively between Really Care Management and Company named above. To formalize this contract, please provide authorized electronic signature below and submit the form.

If you have any questions regarding this Vendors Contract Form,
our Standards of Excellence or your company's qualifications,
please feel free to e-mail us using the link below.

E-Mail us at: Really Care Management

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