Organization Information

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  • Organization Type is required.
  • Organization Name is required for the Organization Type that is chosen.
  • Zip Code is required.
  • Invalid Zip Code. Please enter a valid zip code.
  • Mailing Address 1 is required.
  • Primary Phone number is required.

Enter the following information for the user:
* indicates a required field.

* Organization Type  Company
   Individual
   Government Agency
   State Agency
   Firm
  

* Organization Name
 Not required for Individual.

 Department/Unit
* Zip Code
This populates the City and State values
* Mailing Address 1
 Mailing Address 2
 Mailing Address 3
 City
 State
* Primary Phone
 e.g. 601-555-1234

 Secondary Phone
 e.g. 601-555-1234

 Fax Number
 e.g. 601-555-1234


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