RECEIVING STATION INFORMATION

Use this form to submit company information. Fill in all the fields and then click the submit button to send your completed information. Use the Clear Form option to erase form entries.


CDC Code:
Company Name:
Company Address 1:
Company Address 2:
City, State, Zip:
Contact Phone:
Alternate Phone:
Customer Business Hours
Business Day Open Close
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Holidays
Emergency Number During Customer Business Hrs:
Emergency Number Outside of Customer Business Hrs:
Routine Receiving Equipment:
Fax Modem/Printer E Mail Voice/Telephone
E-mail Address:
Receiving Station Phone Number or Computer Address:
Hours Sent To Each Receiving Station:
Customer:
By:
Title:
Date:
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