Spread of hours Setup Request Form

Spread of Hours Request Form

Email:Enter the same email address which you signed in with:

Applicable company codes:For multiple companies, enter all company codes separated by a comma. IE. 9999, 9999A, 9999B

Which counties/cities do you provide services in?For multiple counties, enter all counties separated by a comma.

Do you currently indicate the visit county/city in the time file?

Yes

No

Comments

I agree to the $300 Spread of Hours Setup fee per company

Agree

Please allow 10 business days for reveiw

FC

· I understand that it is the client’s responsibility to verify that all items were set up as requested, and it is the client’s responsibility to test the accuracy of the calculations resulting directly or indirectly from this request

· In no event will ADS be liable for any direct, indirect, incidental, consequential, punitive, or monetary damages, occurring as a result of this request, whether or not such damages were foreseeable and even if ADS was advised that such damages were likely or possible

.

Agreed