Scottsdale (480) 767-8400 Payson (928) 474-2200 Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Preferred Appointment TimeMorningAfternoonNo PreferencePreferred Appointment DayMondayTuesdayWednesdayThursdayFridayNo PreferencePurpose for Appointment & Additional Information*Preferred Location Payson Scottsdale How did you hear about us?*Internet SearchSocial MediaSecond Chance Program ApplicantOther WebsiteWe will receive and process this information at the beginning of the next business day. Please Specify:* EmailThis field is for validation purposes and should be left unchanged.
