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  3. DVR-19967-E

Wisconsin Business Enterprise Program Equipment Request Form

Document Number:  DVR-19967-E

Description:  This formed is to be completed, signed, and submitted by Licensed Operators of the Wisconsin Business Enterprise Program (BEP) for the purpose of informing the State Licensing Agency (SLA) of opportunities to add or replace equipment into locations currently serviced by the program. All equipment requests must adhere to federal regulations and have a per unit acquisition cost of more than $1,000. Additional instructions can be found at the bottom of this form.

Comments:  Form is protected from modification and enabled for form fill (includes tabbed fields for form completion).

Document Attachment: DVR-19967-E

Content Contact:  DVR Forms

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.

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