IMPORTANT: Please have available the following documents:
- PDF/JPG copy of a clinic utility bill (water, waste, electric, cable, landline)
- PDF/JPG copy of your clinic's voided check
- Color copy front and back of the Owner's drivers license
Save for later: If you need to save this application for later, their is a link at the bottom that will allow you to do this. Be sure to keep the link safe as this is how you will access the form at a later time.