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Charlotte Regional Group Purchasing Organization
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Citizen Information
*First Name:
*Last Name:
*Home Phone:
Work Phone:
E-Mail:
Your Address
(Example: 1507 W 4TH STREET EXT)
House Nbr:
(1507)
Apt:
Str Direction:
E
N
NE
NW
S
SE
SW
W
(W = West)
Street Name:
(4TH)
Street Type:
AVENUE
BOULEVARD
BOULEVARD
CENTER
CIRCLE
COURT
COVE
DRIVE
HIGHWAY
LANE
PARKWAY
PLACE
ROAD
STREET
TRAIL
WAY
(Street)
Street Suffix:
CONN
E
EXT
LOOP
N
NB
NE
NW
RAMP
S
SB
SE
SW
W
(Ext = Extension)
City:
State:
ZIP:
Location of Problem/Service
Use Same Address As Above
(Example: 1507 W 4TH STREET EXT)
House Nbr:
(1507)
Apt:
Str Direction:
E
N
NE
NW
S
SE
SW
W
(W = West)
Street Name:
(4TH)
Street Type:
AVENUE
BOULEVARD
BOULEVARD
CENTER
CIRCLE
COURT
COVE
DRIVE
HIGHWAY
LANE
PARKWAY
PLACE
ROAD
STREET
TRAIL
WAY
(Street)
Street Suffix:
CONN
E
EXT
LOOP
N
NB
NE
NW
RAMP
S
SB
SE
SW
W
(EXT = Extension)
City:
Charlotte
Davidson
Cornelius
Huntersville
Pineville
Matthews
Mint Hill
Location Comment:
Request Details
Please provide some information about your request.
Comments:
version 1.0.6
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