HealthLink ID Card Logo Request Form

Please complete the fields below to submit your request for a HealthLink Logo for your client ID Card. After you submit your information a contract outlining HealthLink logo usage requirements will be faxed to you. If you are in agreement with the terms, please sign and return the contract by fax to the number indicated on the contract. Once we have received your signed contract, we will send you an electronic logo file by email.

Requestor Information
* Name: (Last name, First name)
* Phone:
- - x
* Fax:
- -
* Email Address:
Company Information
Company Name:
What will you be using the logo(s) for?
Choose the ID Card Logo(s) You Require

Black and White

Image Format(s):
.jpg (JPEG)
.tif (TIFF)
.bmp (Bitmap)
.ai (Adobe Illustrator)
Security Code
* Enter the code displayed in the image below:

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