< Back to Client Support Deposit Material Evaluation Request Please use this form to request a Deposit Material Evaluation. Please use this form to request a Deposit Material Evaluation. Your Name* First Last Request InfoYour Company Name* PRAXIS Agreement Number* Are DME services included in your agreement?* Yes No Who is paying for the DME?*BeneficiaryDepositorName of party responsible for payment* First Last Email address of party responsible for payment* Where should we send a copy of the DME report?* Please enter a valid email address. Additional informationPlease use this section to provide any additional information regarding this request. NameThis field is for validation purposes and should be left unchanged. Δ
