Certification Training Intensive – Agency Inquiry Agencies wanting to sign up multiple people please fill out the following form. NHI CTI Purchase Order / Invoice / Quote Request FormIf your company requires a purchase order or invoice or quote to attend an NHI CTI, please use this form to submit your request. We do not issue quotes, instead an invoice is generated. You may use this invoice as a quote and once we receive your purchase order the same invoice will be updated with the purchase order and submitted to the proper accounts payable department accordingly. Name of Requestor(Required) First Last Organization Name / Agency Email of Requestor(Required) Enter Email Confirm Email Phone Number of Requestor(Required)CTI DetailsAny pre-established agreement with NHI will override the below and be reflected on your invoice/quote. Please click the arrows or enter 0 for zero, do not leave blank.Choose the CTI you want to attend(Required)July 2023October 2023If multiple CTIs, please submit a separate form for the other CTIs you / your group wish to attend.CT - First Time Attendee Quantity(Required) Price: $1,999.00 Quantity AT - Returning Attendee Quantity(Required) Price: $999.00 Quantity Total Please enter the names of the participants (can be changed later)NameEmailPhone Number Add RemoveOnce an invoice is paid we send a registration link to bypass our online payment system and each individual is required to use the link in order to register. You will have an opportunity to amend the names later should anything change during the purchase order / invoice / payment process. If you do not know, you may leave blank unless it is a requirement for the names to appear on the invoice in order for the purchase order to be processed.Accounts Payable InformationAccounts Payable Contact First Last Accounts Payable Email (or where to email invoice) Enter Email Confirm Email Bill To Email if applicable Enter Email Confirm Email Billing Phone NumberAddress(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Other Accounting RequirementsSee confirmation screen after submission for links to additional documents such as W-9, etc.Please list any other requirements for a purchase order to be created and/or paid(Required)NameThis field is for validation purposes and should be left unchanged.
