IHR Hosted Egg Donor Database - Order Form

IHR Hosted Egg Donor Database - Home Page

Complete and submit this Order Form to sign up to use the IHR Hosted Egg Donor Database. IHR began offering the IHR Hosted Egg Donor Database to Clients in July 2006. By completing this Order Form you are agreeing to the IHR Hosted Egg Donor Database Agreement.

1. Review IHR charges:

2. Select the number of donors you wish to enter into the IHR Database:

1-99 donors
100-199 donors
200-299 donors
300-399 donors
over 400 donors

3. Select the amount of donor information you want to offer to prospective recipients:
    More information

Tabular view only
Tabular view + donor details
Tabular view + donor details + donor file download

4. Select the level of access you want to allow prospective recipients to have without a password:

Restricted Access:  No one can view your tabular display of donors or donor details, unless they get a password from you.
 
Moderate Access:  Anyone can view your tabular display of donors. However, they must get a password from you if they want to view the donor details. This is the recommended level of access.
 
Open Access:  Anyone can view your tabular display of donors and donor details without a password.

5. (Optional) IHR will supply you with a Username/Password that you will give to prospective recipients. If you have a preference for the user Username/Password that you will pass out, please enter below:

Username:
Password:

6. How do you want prospective recipients to contact you to get a Username and Password. Please be specific, such as "Call our Donor Coordinator at 825-745-2347" or "Email us at eggdonors@agency.com."

7. Enter any special instructions below:

8. Enter the following information about you and your organization:

Your name
(First, Last):
Your title:
Your phone #:
Your email address (required):
Organization
name:
Organization home page web address (URL)

 

*** NOTE ***
If you are already an IHR client,
we will use billing information we have on file.
Please skip to #11.

9. Enter billing contact information, to whom invoices should be emailed. 

  • If you are already an IHR client, we will send invoices to the contact we have on file.
Billing contact name
(First, Last):
(Enter only if different from "Your name" above)
Billing contact's
phone #:
(Enter only if different from "Your phone #" above)
Billing contact's
email address:
(Enter only if different from "Your email address" above)
Billing Address
     Street:
        City:
      State:
          Zip:
   Country:

10. Provide payment information:

  • If you are currently an IHR client and have supplied IHR with your credit card information, then you do not need to complete item #10.
  • Credit card payment is required to use the IHR Hosted Egg Donor Database.
  • Service period is monthly, payable in advance of service.
  • Purchase Orders are acceptable.
  • When the next payment is due, IHR will automatically send an invoice. Then, IHR will charge the credit card number on file, a few days later.
  • You can cancel the service at any time. Please provide at least 15 days notice.
Payment method: visa.gif (1190 bytes)        mastercard.gif (849 bytes)
Cardholder name:
Card Number:
Expiration Date:
Customer Code:
Typically a 3-digit code located on the back of your credit card

11. Click on the Submit button below.

By completing this form:

  • You agree to the IHR Hosted Egg Donor Database Agreement.
  • You understand that the IHR Egg Donor Database is offered as a way for IHR clients to effectively display their donors online. It is not offered as a way for clients to get more traffic from IHR. If you want more traffic, you can sign up for IHR promotion services.
     

    

Quicklinks -
IHR Services for Fertility Organizations

1. Promotion 2. Website Development 3. Website Hosting 4. Egg Donor Database