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ACCOUNTS PAYABLE
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Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
LOCATIONS
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How many locations will be requesting our services?
One location
2-3 locations
more than 3 locations
If you have more than one location, would you like us to invoice each facility separately or all together?
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Separate
All together
If the facilities/locations are to be invoiced separately, do they go to the same Accounts Payable Department or do they go to different people?
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Same Accounts Payable
Different Person for each facility
Upload a List of Locations/Programs along with Office Manager and Contact Info
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REQUESTOR INFO
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