Common use of PLEASE TYPE OR PRINT CLEARLY Clause in Contracts

PLEASE TYPE OR PRINT CLEARLY.  Individual providers must enter their last name, first name and middle initial. All other applicants (e.g., a licensed business) must enter the complete business name as licensed/certified.  If the applicant is employed/contracted by a business, or in partnership, enter the name of the business you are employed by, affiliated with, contracted with, or in partnership with.  Proof of the EIN number (federal tax number) is REQUIRED.  Providers must attach a copy of their licensure/certification, as applicable.  The SSN is required for an individual and is confidential to be used only for the administration of the program.