The UTC's website has moved! Visit our new site at http://www.utc.wa.gov. Please update your bookmarks and favorites.


Pre-authorization Form
* Required Fields
Required fields must be completed or this authorization will be rejected.

*Company Name:
*Company Address:
*Company City:
*Company State:
*Company Zip:

*Contact Name:
*Contact Phone:
*Contact Fax:
*Contact E-Mail Address:

*Authorized Company E-mail Addresses:

Enter multiple E-mail address separated by a comma.
Comments:


If you want a printed copy of this form print now.


 

spacer
Access Washington Logo
360-664-1160 | PO Box 47250, Olympia, WA 98504-7250
Contact Us | Site Map | Privacy Statement | Site Notice & Info | RSS