Screen Six: Acceptance Agreement |
Purpose |
Online Form |
Click on the VFC Acceptance Agreement link to open a new window with the first four pages of the online forms: The Provider Enrollment and Legal Agreement pages. The Legal Agreement needs to be signed and all pages returned to the VFC Administrative staff. The person submitting has the option of scanning the signed pages and sending via email, sending a fax or sending via mail. The printed and signed copy must be on file with the State of Wisconsin, VFC Program for the Provider Registration or Renewal to be valid.
Your application can be sent via Fax, Mail, or E-mail to:
Fax: (608) 267-9493
Notes |