Request for Online Proposal

In order for us to provide you with an online proposal, please complete the following questionnaire and “submit” to Credentialing Solutions.
Responses will be sent via e-mail unless otherwise requested.
If you wish to request a proposal without completing this questionnaire, please e-mail your request to or call 888-273-3368 x 17.
(m) = mandatory field
Requesting Organization Information
Organization (m)
Contact (m)
City State (m)  Zip 
Phone (m)  Email (m) 
Type of Organization (m)
Credentialing Standards (m)
Is this a one-time project ? (m) Is this project ongoing ? (m)
Network Size/Number of providers (m)
If you used a search engine to locate our website, please indicate which engine was used
Special Circumstances or Deadlines