Space for description of services, invoice number, addressee information and terms of net cash payment. Tear out original for customer; copy remains bound in book for permanent reference. Black-print carbonless copies.
Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR...
Space for description of services, invoice number, addressee information and terms of net cash payment. Tear out original for customer; copy remains bound in book for permanent reference. Black-print carbonless copies.