Appendix J - NMEDA Monthly Label Use Form

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APPENDIX J - NMEDA Monthly Label Use Form

 

Reporting Year/Month: ______/____

 

NMEDA Label Number

Customer Last Name

Vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     
     
     
     
     

 

Columbus Mobility Specialists, Inc. may provide customer information only where allowed by law.  RADCO shall only use customer information to support statistical reporting.  RADCO shall hold all customer information as confidential and shall not transmit any customer information to NMEDA or any other party.


Page Revision Date
12/23/2002

NMEDA QAP
Manual Page 24