Azfmc

    If you only need one or two Provider Directories, we encourage you to use our Provider or Facility Search to find a current list of providers that meet your needs. Then choose “View PDF” on your search results page to get a customized, printable directory without having to wait for shipping and handling. If you need more than two AFMC Participating Provider Directories, please fill out the request form below. Once we receive and verify the form, we will ship the Participating AFMC Provider Directories as requested.

Name
email
Phone
How many directories
do you need?
Quantity
Who you are:
Individual     
Carrier     
Provider     
Group     
Broker
For: Marketing     
  Employer     
  
Shipping Info: *Only if different from above  
*Name      *Phone 
Company      Fax 
Address  
City   State   Zip 
Note: Incomplete forms will not be processed. Cancel     

document.drform.youare[0].checked=true;

function hideshow(){
if (document.drform.youare[4].checked==true){
document.drform.broker[0].style.visibility=’visible’;
document.drform.broker[1].style.visibility=’visible’;
document.getElementById(‘mark’).style.visibility=’visible’;
document.getElementById(’emp’).style.visibility=’visible’;
}else{
document.drform.broker[0].style.visibility=’hidden’;
document.drform.broker[1].style.visibility=’hidden’;
document.getElementById(‘mark’).style.visibility=’hidden’;
document.getElementById(’emp’).style.visibility=’hidden’;
}
if (document.drform.broker[1].checked==true){
document.drform.groupname.style.visibility=’visible’;
}else{
document.drform.groupname.style.visibility=’hidden’;
}
}

hideshow(); //run once when the page loads

function filledout(){
if (document.drform.dqty.value==””&&document.drform.cqty.value==””){
alert (“You have not specified any quantities to send.”);
return false;
}
if ((document.drform.dqty.value*1) < 3&&(document.drform.cqty.value*1)<3){
alert ("If you only need one or two Directories,please use the Provider Search and choose'View PDF' on the search results page.");
return false;
}
return true;
}