Follow the steps to complete the MI Licensure Application Invoice

1. Click 'Get Form' button to obtain the form and open it in your preferred editing tool.
2. Begin by entering the name of your facility in the 'Name of Facility' field at the top of the form.
3. Provide the facility's address, including the street address, city, state, and zip code in their respective fields.
4. Fill in the contact person's name, phone number, and email address to ensure proper communication regarding your application.
5. Select the type of facility from the provided options, such as 'Freestanding Surgical Outpatient Facility' or 'Nursing Home.' Make sure to check the appropriate box.
6. Enter the Sigma Account Number, ensuring the correct one is used as listed on the form.
7. Indicate the name of the remitter by filling in the check information area, which should match the name on the upper left corner of the check.
8. Specify the applicable fees: the Application Fee and Licensing Fee as listed on the form. Total these amounts to ensure proper payment.
9. Write the check number corresponding to the payment you are submitting.
10. Remember that remittance of the fee must occur before the licensing action can be finalized. Make the check payable to the State of Michigan.
11. Submit a copy of the invoice, the completed application, and the check to the specified address for MDLARA, BCHS.
12. For overnight payments, ensure you use the alternative address provided at the bottom of the form.
13. Once you have filled out all sections of the form, save your changes. You can then download, print, or share the completed form as needed.

Complete your MI Licensure Application Invoice online today to ensure timely processing of your licensing application.