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SAMPLE REQUEST FAX FORM To receive your complimentary samples of (transdermal system) CII 4 mg patch, complete this form and fax it, along with a copy of your DEA license, to: Sample Order Full?lament

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What is sample request fax form?

The sample request fax form is a document used to request a faxed copy of a specific form or document.

Who is required to file sample request fax form?

Anyone who needs a faxed copy of a form or document may be required to file a sample request fax form.

How to fill out sample request fax form?

To fill out the sample request fax form, one must provide their contact information, the document or form they are requesting, and the recipient's fax number.

What is the purpose of sample request fax form?

The purpose of the sample request fax form is to request a faxed copy of a specific form or document for convenience or urgent situations.

What information must be reported on sample request fax form?

The information required on the sample request fax form typically includes the requester's name, contact information, the document or form being requested, and the recipient's fax number.

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