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DocuSign Envelope ID:6E9B5308-6677-4F2E-9268-29D6E1A4FD76 <br /> LETTER AGREEMENT <br /> TI L <br /> WorkSTEPSOEmployment Testing <br /> Price List/Company Information/Special Instructions <br /> s <br /> DATE: <br /> COMPANY NAME: <br /> TYPE OF BUSINESS: <br /> i <br /> ADDRESS: <br /> CONTACT PERSON BILLING: <br /> PHONE: FAX#: <br /> CONTACT PERSON TEST RESULTS: <br /> PHONE: FAX#: <br /> PRICES: <br /> JOB ANALYSIS $ <br /> POST-OFFER EMPLOYMENT TEST(BASIC) $ <br /> POST-OFFER EMPLOYMENT TEST(COMPREHENSIVE) $ <br /> CARPAL TUNNEL TEST $ <br /> POST EMPLOYMENT FIT FOR DUTY TEST $ <br /> FUNCTIONAL CAPACI'T'Y EVALUATION <br /> OTHER(SPECIFY ) $ <br /> SPECIAL INSTRUCTIONS: <br /> Company Representative/Title Date <br /> Provider Represeritaiive%Title Date <br />