HomeMy WebLinkAboutMHN4/17/2013
P.O. Box 10697
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ltCompanym San Rafael, CA 94912 Heah Net '
Town of Los Altos Hills
MHN Training Department
Town of Los Altos Hills requested the following service from the MHN Client Services
Training Department.
Documented below is the fee estimate:
The fee estimates for each service may change depending on the length of the
service / trainer's travel time.
Please complete the billing information below and fax it to 866-692-7855.
Payer Name: �OUJA C-)+ L6S � i 40's [S
Payer Phone Number: -1 0__a -S 13
Payer email address:
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Payer mailing address: � 3�.� ��Y�'I,Q✓1�' ,�0qg�, � �'�'� ����1 C ��'�
Payer Signature:
The service listed above has been approved for payment as defined.
Special Note: A -cancellation fee will be assessed if any services are cancelled less than 5
business days prior to the scheduled training date.