MAP4630
FL. Chartreuse
Code ML
MAP4650
FL. Orange
Code ML
MAP4660
FL. Orange
Code ML
MAP2500
FL. Chartreuse Code JJ
MAP2350
FL. Orange Code JJ
MAP4620
FL. Chartreuse Code MN
MAP4640
FL. Orange Code MM
MAP4670
FL. Orange Code MN
INSURANCE ACCOUNT INFORMATION
PATIENT NAME (if dependent)
EMPLOYEE NAME
SOCIAL SECURITY NUMBER OF EMPLOYEE
BIRTHDATE
EMPLOYER
UNION NO.
GROUP PLAN NAME
GROUP NO.
PRIMARY CARRIER NAME
POLICY NO.
SECONDARY CARRIER NAME
POLICY NO.
RELATION TO EMPLOYEE
■
SELF
■
SPOUSE
■
CHILD
■
OTHER
MAP1080
FL. Red
Code HH
MAP2180
FL. Chartreuse
Code HH
MAP1070
FL. Red
Code HH
MAP3040
FL. Red
Code ML
MAP2370
FL. Pink
Code HH
MISSED
APPOINTMENT
ON
MAP305
FL. Chartreuse
Code MB
UL825
FL. Red 3” x 2” 320/Roll
Code MC
COLLECTION SUMMARY
Amount
Date final notice sent
Date placed in collection
Date placed with agency
Comments
Approved by
MAP4680
FL. Chartreuse Code MN
Keep clients informed about
payment options and watch your
accounts receivables improve.
MAP2340
FL. Chartreuse Code JJ
UL826
White 4” x 2-5/8” 240/Roll Code MC
Label Code Information
Label Code
Size
Qty Per Roll
HH
1-1⁄2” x 7⁄8”
250
ML
MN
3” x 1”
250
MB
1-1⁄4” x 5⁄16”
500
MM
3-1⁄4” x 1-3⁄4”
250
JJ
MC – Special size labels come in different quantities.
Credit Card Labels
IFS_Catalog_Sept_2011_Body_V5.indd 78
9/18/11