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Clear FormTRANSITIONING CONSUMER DATA FORM Consumer Information Consumer Name in ProgramFirstMiddleLastStreet Address (Physical address where services will be provided. No PO Box.) City Prostate VAHomeZipCountyCellFaxMedicaid
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Start by writing your full name at the top of the address section.
02
Write the street name and number on the next line.
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If applicable, include any additional information such as apartment number or floor.
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Write the city name on the line below the street address.
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Specify the state or province on the next line.
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Write the postal code or zip code on the following line.
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Finally, include the country name at the bottom of the address section.

Who needs physical address where services?

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Individuals who avail services that require physical delivery or on-site visits.
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Businesses that offer products or services through mail order or e-commerce.
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Organizations that need to provide an official mailing address for legal or administrative purposes.
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Government institutions that require physical addresses for communication and identification purposes.
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The physical address where services refers to the actual location where business activities or services are conducted.
Businesses and organizations that provide services must file their physical address where services are rendered.
To fill out the physical address where services, provide the complete street address, including street number, street name, city, state, and zip code.
The purpose of the physical address where services is to ensure accurate identification of where services are provided for regulatory and tax purposes.
Information that must be reported includes the exact address, business name, type of services offered, and contact information.
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