Acanza - Health Group

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Hours:
Mon-Thurs: 9am-7pm •  Fri: 9am-8pm
Sat: 9am-7pm  •  Sun: 10am-6pm
  • Completed and Signed Application PDF File (the blank PDF file must be downloaded from HERE):
    • PDF File:
      Upload files
       
  • Upload 3 Forms of Customer Identification such as State Driver License or ID / Passport / Visa / Green Card / Birth Certificate (can be JPG, PDF, PNG, BMP, or mobile camera format):

    • First Form of Identification:
      Upload files
       
    • Second Form of Identification:
      Upload files
       
    • Third Form of Identification:
      Upload files
       
  • Upload Proof of Arkansas Residency (if your supplied forms of ID do not prove residency in the state of Arkansas in JPG, PDF, PNG, BMP, or mobile camera format):
    • Electric Bill, Phone Bill, Mortgage Statement, etc.
      Upload files
       
  • Upload Proof of Income Document (can be JPG, PDF, PNG, BMP, or mobile camera format):
    • Employee W2, Paycheck Stub, etc.
      Upload files
       
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