Billing Request Form - DOC by olliegoblue35

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									                          State of Georgia Billing Request Form




Agency name: __________________________________________________

Travel Contact:_________________________________________________

Billing Contact: _________________________________________________

Billing Address: ________________________________________________

Phone Number: _________________________________________________

Email Address:__________________________________________________


Pertinent Information you would like to see on the invoices: Example: ORG Code

___________________________________________________________________




How would you like to notify the travelers of the account number?


                                             anet
     -site administrative training

                                        option

Account Number (Enterprise Use):



Please fax to 1-800-961-8371 or email to heather.pastrick@erac.com

								
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