Get You Will Be Automatically Entered On The Plan-holders List - In

Filling out the 'You Will Be Automatically Entered On The Plan-holders List - In' form is an essential process for plan-holders seeking to ensure their inclusion in the necessary registration. This guide provides clear steps to help you navigate the process effectively.

Follow the steps to fill out the form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it for entry.
2. Provide your company name in the designated field. Ensure the name is accurately reflected as it will be submitted.
3. Enter the street address of your company. This information is crucial for correspondence and records.
4. Fill in the city where your company is located. Make sure to use the legal and official name of the city.
5. Input the zip code associated with your street address to ensure precise location identification.
6. Provide your Federal ID number in the specified field. This is important for tax identification purposes.
7. Enter your primary phone number to allow for easy communication. Make sure this number is active.
8. Input your FAX number if applicable, providing a reliable means for document submission.
9. Include your email address for electronic communication and updates regarding your registration.
10. Identify the person submitting the form by entering their name in the ‘Submitted by’ field.
11. Specify the state where your company operates, ensuring it aligns with the address provided.
12. Review all entered information for accuracy before submission.
13. After verifying the details, save any changes you've made. You can choose to print the form, download it, or share it digitally as needed.
14. Submit the completed form via FAX to 317-232-0676 as indicated, ensuring it reaches the appropriate department.

Complete your document online today to ensure your entry on the plan-holders list.