S e c t i o n I ( to b e co mp l ete d by l o ca l a ge n c y CPA ) I ...
6 . Do e s d i a gn o s i s matc h p ro d u c t i n d i cat i o n s ? S e c t i o n I I ( to b e co mp l ete d by state WI C o f f i c e staf f ) 7 . U PC: 8 . Pro d u c t s i ze a n d p hys i ca l fo r m: 9 . Re co n st i t u t i o n a mo u nt p e r u n i t : 1 0 . Reta i l co st : 1 1 . Do e s p ro d u c t me et mi n i mu m re q u i re me nt s ................
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