Fld Name /
|
Instruction |
(a) Name of Provider |
Enter complete name of Provider, page 1. |
(a) Name of Provider |
Enter complete name of Provider, page 8. |
(b) Signature of Provider |
Enter signature of Provider’s authorized person, page 8.
If you are mailing or faxing this form, print the form and manually enter your signature. Submit the original of the completed form in hard copy or facsimile to the Kansas City Commodity Office, FSA. |
(c) Title of Provider |
Enter title of Provider’s authorized person, page 8. |
(d) Date |
Enter date of signature of Provider’s authorized person, page 8. |
Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Instructions for WA-460-9 |
Author | Preferred Customer |
File Modified | 0000-00-00 |
File Created | 2021-01-28 |