CFD HAT Purchase Request
Please complete the following information to purchase the CFD HAT
If you have any questions, please contact Barbara Simeon at 607-352-1340 or 607-759-4175 or
PCQI Contact Name
PCQI Contact Email
PCQI Contact Phone
PCQI Certificate Number
Number of facilities you will Purchase for:
4 or More
Address for each facility (please include the name of the facility, street address, city and state
How do you plan to receive the required training?
In person at CFD in Conklin
In Person if a training closer to my facility can be offered
Unsure at this time
Do you have EXCEL 2010 or higher (able to open .xlxs files)?
I don't know
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