GROUP PURCHASING AGREEMENT

Group Purchasing Program (check the appropriate program):


 Acute Care ___
Blood Community ___
Lab & Research ___
Physicians and Clinics ___
Plasma Industry ___
Tissue and Organ Banks ___


Organization _________________________________
Address _________________________________
_________________________________
City, State, Zip _________________________________


By signing below, you are indicating that your organization wants to access the Group Purchasing Program offered by Webster & Associates, Inc. allowing your organization to take advantage of the Program benefits and discounts. Signature also indicates your acceptance of the terms and conditions of the Program.

In addition, you agree to keep all Program information (including prices) confidential.

Authorized Signature _________________________________
Title _________________________________
Name (print) _________________________________
Date _________________________________
Phone Number _________________________________



Please send this completed form to:

Webster & Associates, Inc.
1819 Pembroke Road
Greensboro, NC 27408-7901
Phone (336) 273-8999
Fax (336) 272-2721