MyHealthScore.com On-Line Organization Subscription Agreement

MyHealthScore.com and the "Subscriber" (identified above) enter into this agreement effective upon the date shown below, according to the following terms and conditions:

Service: MyHealthScore.com agrees to provide certain internet accessible health care data processing capabilities from its site identified by the URL listed below. The purpose is to provide cost and quality information to the public as well as the employees of each organization associated with MyHealthScore.com. A summary report by provider type will be available on-line representing the experience of the organization's employees which have been collected on-line.

URL Address: Uniform Resource Locator: "http://www.MyHealthScore.com"

Term: The length of this agreement shall be for a period of three years, and remain in effect continuously thereafter except that either party may erminate this agreement, without cause, at the end of the monthly or annual renewal dates.

Maintenance: MyHealthScore.com will ensure the proper operation of its internet site and the Subscriber will be responsible ensuring the accuracy of the data displayed on their pages.

Hold Harmless: Both parties agree to hold each other harmless for errors or omissions referenced in the MyHealthScore.com internet site.

MyHealthScore.com Data Usage: The Subscriber agrees not to make public reference to other individual Non-Subscribers or Subscribers identified by the MyHealthScore.com internet site.

Subscriber Information:
User Name: Primary Contact First Name:
Organization Name Primary Contact Last Name:
Street Address Primary Contact Title
City Primary Contact E-mail Address
State Primary Contact Area Code and Phone Number
Zip Code Primary Contact Area Code and Fax Number
Area Code and Phone Number Password (8 to 20 characters):
Organization E-Mail Identifier Confirm new Password:
(This will be used by the report
generator, e.g. @my_firm.com)		 Count of Employess


Fees are $2.00 per employee upon starting this agreement and $.50 per employee per month while this subscription is in effect.
Credit Card Option - begin account immediately and reduce all fees by 4%
Payment Method

The following information is necessary for credit card transactions:
    Cardholder's Name:
    Account Number:
    Type:
    Expiration Date:
Internal Reference Code: