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NCCtraining <br /> 620 Coolidge Dr.Suite 100,Folsom,CA 95630 <br /> NARCOTICS,CLAN LABS&ILLICIT CANNABIS (916)353-2360/(800)NES-ADV!SE/Fax(916)353-2375 <br /> -A DIVISION OF NES- www.nesglobal.net <br /> Client Information Form <br /> The purpose of this form is to ensure that point of contact and billing information for our clients is managed accurately and efficiently.Please fill <br /> in or update the below fields(if needed)and return this form to the NES representative from whom you received it. <br /> Please provide point of contact(POC)information in the following table.The POC is the individual responsible for coordinating services to be <br /> performed by NES,for serving as site liaison,and/or to whom training certificates,plan documents,or other pertinent materials are to be sent <br /> prior to and/or following provision of contracted services.ifservices are to be provided at an alternate address,please inform in comments field. <br /> Point of Contact(POC) <br /> Company/Agency/Organization <br /> Name(or DBA Name) <br /> POC Name&Title <br /> Line I <br /> Line 2 <br /> Address <br /> Line 3 <br /> Line 4 <br /> Office <br /> Phone Mobile <br /> Fax <br /> POC Email <br /> Comments/Special Instructions <br /> Please provide billing contact information in the following table including the company/agency/organization name to be used for billing <br /> purposes.If some or all billing information is the same as in the above table,you may check this box to auto-fill the below table: ❑ <br /> Billing Contact <br /> Company/Agency/Organization Name <br /> Billing Contact Name&Title <br /> Line I <br /> Line 2 <br /> Address <br /> Line 3 <br /> Line 4 <br /> Office <br /> Phone Mobile <br /> Fax <br /> Billing Email <br /> Comments/Special Instructions <br />