If this facility employs a management company, please provide following information:

Company Name

• Enter the Managing Company Name

• Must be a company name, not an individual name

Address

• Enter the address information in this field

City

• Enter the appropriate city for the applicable address

State

• State defaults to Kentucky but is editable

• Select the appropriate state from the drop down box

Zip Code

• Enter the appropriate zip code for the applicable address entered

Zip+4

• If known, enter the appropriate +4 Zip code

For applicants enrolling under Individual Category, the system shall default value to N/A and the user will not be able to modify any fields on this screen.  They may click “Exit,” “Back,” or “Save & Next”

If fields are entered then N/A is checked, the data entered will be cleared

Special Characters:

• The following Special Characters cannot be used in the situations below. Field properties will not allow the following characters in the box:

 For First Name, Business Name, Other name (if any):    | + \ '

 For Last Name field:    | + \ ', and numbers are not allowed

 For Comment Boxes:     <  >  ^  ~ ` + | \ / ¬ £

 For Address fields:    | + ! @ # $ ^ * ( ) ? / \ " < > & : ; _

• If you copy and paste an excluded special character, an error message will display after clicking Save & Next

• Remove excluded characters from pasted information or uploaded text in the document

Save & Next:

• When finished, click Save & Next to save the information and proceed to the next page

• Click Back to go to the previous screen without saving

• Click Exit to return to the dashboard without saving

• Note that if the information is not saved, you will lose the data on the current page