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Please provide the best point of contact to be shared with customers for future sales or direct support, inclusive of contact information.
Please list company website, if applicable:
Is your company enrolled in IMPACT to provide home modifications? Select one... Yes No
Is your company enrolled in IMPACT to provide vehicle modifications? Select one... Yes No
Is your company enrolled in IMPACT to provide Remote Supports? Select one... Yes No
Is your company enrolled in IMPACT to provide either adaptive equipment and/or assistive technology? Select one... Yes No
Illinois Department of Human ServicesJB Pritzker, Governor · Dulce M. Quintero, Secretary Designate
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