Pennsylvania Authorization of Representative Authorization Of
Authorization Of Representative Form. (1) the appellant being represented is a provider or supplier; The individual or sole proprietor that is the party;
Web name of authorized representative (print): The individual or sole proprietor that is the party; Web the personal representative must also include his or her address, phone number and relationship to the beneficiary.. Web approval of a representative’s fee is not required if: (1) the appellant being represented is a provider or supplier;
(1) the appellant being represented is a provider or supplier; The individual or sole proprietor that is the party; (1) the appellant being represented is a provider or supplier; Web name of authorized representative (print): Web approval of a representative’s fee is not required if: Web the personal representative must also include his or her address, phone number and relationship to the beneficiary..
