Reporter Forms

Options for submitting reporter billing information

Option One: Fax

Click the link below to obtain and print the form. Fill out the form completely.

Fax the completed form back to us at 954.467.9065.

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.

»Get Adobe PDF Viewer

Option Two: Online form submission

Click here to link to our online billing information form.

JAC Attendance Voucher