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J t� CITY OF CARMEL, INDIANA VENDOR: 370269 R Y
g ONE CIVIC SQUARE ZIRMED CHECK AMOUNT: $ ....
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s ,�; CARMEL, INDIANA 46032 13 1 1 SOLUTIONS CENTER CHECK NUMBER: 307461
97.�. CHICAGO IL 60677-1311 CHECK DATE: 01/20/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 524185 226.70 SUBSCRIPTIONS
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INVOICE Date 12/12/2016
Invoice# 524185
Account# 125191
Www ZiwmL t�uM For overnight or Due Date 1/11/2017
correspondence ONLY: Customer PO#
Invoice questions?Please call(877)494-7633
option 4 ZifMed, Inc.
Attn: Accounting Dept
Email:billinginquiry@zirmed.com 888 W.Market St., Ste 400
Louisville, KY 40202 Amount Paid
Customer Support or Sales:(877)494-7633
Bill To PLEASE REMIT ONLY PAYMENTS
City of Carmel Fire Department TO THE FOLLOWING:
2 Civic Square ZirMed Inc.
Carmel IN 46032 1311 Solutions Center
Chicago, IL 60677-1311
Code InvoiceDate Due Date
125191 Zirmed 524185 12/12/2016 1/11/20171
Description City Price Total
Monthly Professional Claims Management Fee 1 99.00 99.00
Paper Professional Claims Filed Previous Month 6 0.45 2.70
Monthly Eligibility System Access Fee 1 100.00 100.00
Monthly Remittance Advice Access Fee 1 25.00 25.00
Invoice Total $226.70
Current 1-30 Days 31-60 Days 61-90 Days Over 90 Days Account Balance
226.70 0.00 0.00 0.00 0.00 $226.70
Would you like your invoice via email? Please email billinginquiry@zirmed.com