Options for submitting reporter billing information
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.
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Click here to link to our online billing information form.