Insurance/Credit card authorization form

Hersheydmd · Post by **Hersheydmd** » Mon Oct 31, 2016 4:25 pm

Does anyone have a credit card authorization form? I already have a recurring payment authorization form, but I need a form for the balance after insurance pays. Thanks in advance.

rhaber123 · Post by **rhaber123** » Wed Feb 01, 2017 11:39 am

check this form and make your own:
http://imaging.ubmmedica.com/all/editor ... POLICY.pdf

Hersheydmd · Post by **Hersheydmd** » Tue Jul 18, 2017 8:08 pm

Here is my insurance/credit card authorization form:

: 2017-07-18.png (122.02 KiB) Viewed 5803 times

Insur_auth-and-credit_card.xml: (32.43 KiB) Downloaded 386 times

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Insurance/Credit card authorization form

Insurance/Credit card authorization form

Re: Credit card authorization form

Re: Insurance & Credit card authorization form