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Provider Information for Knit-Rite Direct Facility Patient Brochures

Please provide the information below as it is to appear on the back of the patient brochures for your facility. If you have multiple locations, please submit each location in a separate form.

Providing your logo is optional. If you would to include, we request that you submit your logo as a high res (300 dpi) JPEG.

 

Facility Name:
Facility Street Address:
Facility City, State & Zip Code:
Phone #:
Facility Logo
Person of Name Submitting:
E-mail Address where Final Proof should be sent:
Ship brochures to the Facility Address provided above (address that prints on brochures).   
If shipping brochures to different address, please provide address:
Ship brochures to the attention of:
Comments / Questions:

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