Alliance Application Review Invoice Request Form

AIMH Information

Name of AIMH

Endorsement Coordinator's Name

Please enter the full name of the Endorsement Coordinator

First Name

Last Name

Endorsement Coordinator's Email

Provide the email address where we can reach the Endorsement Coordinator.

Application Review Information

# of Applications to be reviewed

How many applications are you requesting to be reviewed?

Review Period Start Date

When will the review period begin? (A 3-week advance notice is required prior to the review period starting)

YYYY

Feedback Due Date

When should the feedback be returned?

YYYY

EASy Application IDs

Provide the EASy Application IDs and applicant's names. If you’re unsure of all the IDs, we’ll follow up with you via email.

Additional Details

Please share any other relevant information or special considerations we should be aware of

Billing Information

Billing Person's Name

First Name

Last Name

Billing Person's Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Payment Options

Which of the following should the Alliance expect as a form of payment?

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