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Click ‘Get Form’ to open the blank PACFA application in the editor.
Begin by indicating whether this is a new application or a renewal. Check the appropriate box at the top of the form.
In Section I, provide your contact information. Fill in your full legal name, mailing address, and contact phone number. Optional fields include cell phone and email address.
Move to Section II to enter facility information. List the official business name, DBA (if applicable), operation type, and facility address. Ensure that no P.O. Boxes are used here.
In Section III, check all applicable license categories for your facility operation. Review each category's definition carefully to ensure compliance.
Complete Section IV by certifying that all information is accurate and signing where indicated. Make sure to include any required attachments as specified in the instructions.
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