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Telephonic Billing Codes Magellan Eap Form 2010
Under which accounts payable invoices are paid by Magellan.
Company/Partnership Information
Company/Partnership Name:
Address Line 1:
Address Line 2:
State:
City:
ZIP Code:
Billing Contact Name:
Contact Telephone #:
E-Mail Address for Remittance Information:
Type of TIN:
TIN:
Employer Identification Number
Social Security Number
Bank Information
Bank Name:
Address Line 1:
Address Line 2:
State:
City:
ZIP Code:
Bank Contact:
Contact Telephone #:
Type of...
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