Quality Data Processing, Inc.

Technical Support Request Form

Name:
Company:
Address:
City:	ST:	Zip:
Phone:
Fax:
Email:

Which of the following Quality Data Processing software products do you need Technical Assistance with (please check the appropriate box)?

MEDIC-AID® HCFA1500 Claims Submission
MEDIC-AID® Community Based Claims Submission
PRI~MED2000® Medical Office Management
MAGNA-MED® Clinical Office Management
MAIL LIST MANAGEMENT CASS certification & mail list management
OFS® Order Fulfillment System
PRO-PAY® Payroll System
UMS® Union Management System

Please describe the problems you are having, be sure to provide detail information on any error messages or program halts you receive.

Quality Data Processing, Inc.

1165 Dicus Mill Road
Millersville, Maryland

local phone: 410-729-2442
toll-free phone: 866-321-0765
Email: Q.D.P.