[COMPANY] Referral Agreement

This Referral Agreement (“Agreement”) grants to the person or entity Referring Party, NAME HERE (“Referring Party”), a STATE corporation, the right to refer to [COMPANY]dba [COMPANY] (“[COMPANY]”), a North Carolina corporation, qualifying new customers (“Prospects”) for the license of [COMPANY]software products directly from [COMPANY]in exchange for a Referral Fee (“Referral Fee”), as set forth below.

1. Referral of Prospects

1.1 To be eligible for a Referral Fee, a Referring Party must identify Prospects directly to [COMPANY]by completing the online referral form from the website (see Exhibit A for attached sample form with instructions). Existing [COMPANY]customers are not eligible as Prospects, neither are customers currently in the pipeline or that [COMPANY] has already invested time to build a relationship, or is currently registered and a Qualifying Transaction by another Referring Party, Reseller, or ASP Provider. Referring Party must successfully register each [COMPANY]product sales lead referred to [COMPANY]The date of the form submission and providing the necessary contact information will be the submission request date. An email will be sent to Referring Party approving or not approving the sales lead. An approved sales lead is hereinafter referred to as a “Qualifying Transaction” and eligible for a Referral Fee upon receipt of payment to [COMPANY]for the applicable sale. All approval of sales leads are at [COMPANY]’s sole discretion.[URL]

1.2 Each Qualifying Transaction is only effective for a period of one-hundred and eighty (180) days from registration. If the sale does not close within such one-hundred and eighty (180) day period, the Qualifying Transaction will expire and Referring Party will need to complete the process in this Section 1.1 again in order to qualify for a Referral Fee.

2. Reserved Rights

2.1 This Agreement shall in no way limit [COMPANY]’s right to sell directly or indirectly any product or service to any current or prospective customers, including Prospects.

2.2 [COMPANY]will not pay more than one (1) Referral Fee on any given Qualifying Transaction, and [COMPANY]reserves the right to apportion a Referral Fee if more than one Referring Party has contributed to the close of a Qualifying Transaction.

2.3 A Referring Party may receive the Referral Fee as follow: $500 for a practice of 10 doctors or less, $1,000 for a practice with 11-20 doctors and $1,500 for a practice with more than 20 doctors. Fees for the performance of services (such as on-site professional service fees and costs, interface development, training costs, maintenance and support fees, maintenance and support renewal fees) and fees associated with subsequent product purchases are not eligible for Referral Fees.