2305 N. Hayes
Fresno, CA 93723
Ph 559-277-1666 (1-800-330-2533) Fax 559-277-2745
www.careproviderusa.com
Email: dbrown@careproviderusa.com

Direct Referral Agreement

Sign and fax back to 559-277-2745 ASAP PLEASE
 

This contract offer is valid for only 30 days from today's date and will expire ___________ if not executed by both parties.

Care Provider USA agrees to place Directory member :
(1)_______________________________________________________________________________________

RCFE on line one will be eligible to receive Referrals from CPUSA for a period of 1 year.  Care Provider USA makes no guarantee of finding residents for RCFE's.  Care Provider USA will be paid _________ % of the first months resident fee  within 3 working days of admission to a care Provider USA directory member's RCFE.  Upon admission of a resident referred by care Provider USA by phone, fax, writing, or email, directory member will remit full payment as stated above and a copy of the admission agreement (if requested) to Care Provider USA.  Directory membership is non-transferable and is valid only for the RCFE shown on line 1.  The Care Provider USA directory member on Line 1 agrees to pay all collection and court costs of any unpaid or past due fee owed Care Provider USA.  A late penalty of 10% per resident daily fee will be added to accounts not paid in full 30 days net.

______________________________________  Date___________________________
Marie Brown, Care Advisor

X_____________________________________  Date___________________________
Directory member or RCFE Administrator

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