REPORTER FORMS

Instructions for Using the Billing Information Form
    Option One: FAX
  • Open the form on our website by clicking on the link below.
  • Print a copy of the form.
  • You may want to save a copy of the form to your computer for future use.
  • Fill out the form completely.
  • Fax the completed form back to us at 954-467-8214.
Billing Information Form (54KB) NOTE: Fax Form is in Adobe
Acrobat Format. Please download
a copy of Acrobat Reader
if you do not already have it.


 
    Option Two: Online form submission
  • Click here to link to our online billing information form.
Online Billing Information Form
 
 
 

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