- Maverick Health Policy

Need an invoice before subscribing to MyMaverick?

Fill out the form below and we will be in touch.

Request an Invoice

Organization Name(Required)

First Name(Required)

Last Name(Required)

Role(Required)

What is your role at the company?

Email(Required)

Phone Number

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Any Additional Comments or Questions?

Please use this section for any additional information, such as any other individuals who should be CC’ed on the invoice, any specifications for who the invoice should be addressed to, or any specifications for who should be designated as the Primary Account Holder for your organization’s MyMaverick subscription, if different than the individual completing this invoice request.