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Guidelines for
Providers and Vendors Information
and Instructions:
Name
of Patient (Assistant Fund Applicant)
Phone Number of Patient Texas Polio Survivors’ Association, Inc. requests that you address your estimate, invoice and any other pertinent documentation to: Texas Polio
Survivors’ Association, Inc. or
fax the supporting documentation to: Disbursements
from TPSA’s Assistance Fund can be made only to the providers of
professional services and medical equipment.
TPSA realizes at the time service is provided or when making
preliminary estimates, you may not know if the applicant will receive
financial assistance. TPSA
asks for your cooperation. If
you require the client to make a down payment and the Assistance Fund
reimburses you for that amount or part of it, TPSA asks that you
reimburse the client accordingly. The
Texas Polio Survivors’ Association, Inc. is a tax-exempt 501 (c)(3)
organization and would appreciate you offering a charitable discount for
your services. TPSA will
provide you with a written acknowledgment for your charity. The
Assistance Fund thanks you in advance for your consideration in working
with us. Sincerely, Send mail to ccortez@sw.rr.com
with questions or comments about this web site.
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