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CITY OF CARMEL, INDIANA VENDOR: 370269 CHECK AMOUNT: $*******224.00*
ONE CIVIC SQUARE ZIRMED
?Q CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 307746
CHICAGO IL 60677-1311 CHECK DATE: 01/27/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 533730 224.00 SUBSCRIPTIONS
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INVOICE Date 1/12/2017
ZI*"'RNEE:Y
Invoice# 533730
Account# 125191
WWW.Zlfamf-l.com For overnight or Due Date 2/11/2017
correspondence ONLY: Customer PO#
Invoice questions?Please call(877)494-7633
option 4 ZlrMed, 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 Invoice# Invoice Date Due Date
125191 Zirmed 533730 1/12/2017 2/11/2017
Description Qty Price Total
Monthly Professional Claims Management Fee 1 99.00 99.00
Monthly Eligibility System Access Fee 1 100.00 100.00
Monthly Remittance Advice Access Fee 1 25.00 25.00
Invoice Total $224.00
Current 1-30 Days 31-60 Days 61-90 Days Over 90 Days Account Balance
224.00 226.70 0.00 0.00 0.00 $450.70
Would you like your invoice via email? Please email billinginquiry@zirmed.com