Referral Rewards Program Name Referral Rewards Program Submissions We are offering a Referral Rewards Program for our Payer Gatewayplus product. Any office/facility that you refer to DataLink will receive a 14-day free trial. If the referred office/facility subscribes after their free trial, your account will receive up to a $45.00 subscription credit on your monthly invoice. There is no limit to the number of subscription credits you can earn! You may submit up to 5 referrals per form submission. Additional submissions require to fill out the form again. Thank you! Your Information Referring DataLink Client (your business) * Account Number First Name * Last Name * Email Address * Practice/Facility to be referred: Name of Practice/Facility * Contact Name * Practice/Facility Phone * How did you hear about us? * Google Bing Referred by Yahoo Google Ads Other Would you like to submit another referral? * YesNo Name of Practice/Facility * Contact Name * Practice/Facility Phone * Providing Excellence Is Our Mission After all, our success depends on yours. 9901 I.H. 10 West, Suite 800 San Antonio, TX 78230 1-800‐845‐0367 ext. 701 Try Our Free Trial!