Act 87 Information Update - New Statute Request

Act 87 Information Update - Statute Request

Statute #

Format: Enter the statute number you need added to the system

Agency Information for Agency Receiving Funds

Agency Name

Format: Enter the agency to which money is being sent due to this statute

Agency Contact

Agency Contact Email Address

Format: name@example.com

Agency Contact Phone Number

Format: (XXX) XXX-XXXX or XXX-XXX-XXXX

Collection Type

In case we need to contact you for more information, please enter your contact information below.