DIRECTORY STRIPS
As of May 6, 2002, charge of $15.00 per strip will be required.
EXAMPLE:
1. Complete Medical Care C-900
Company Name Unit #
2. Doe, John A., M.D. F.A.C.P. C- 900
Last name, First, Middle Professional Designation Unit #
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**PLEASE TYPE OR PRINT LEGIBLY
1. ____________________________________________________
Company Name Unit #
2. _________________________________________________________________
Last name, First, Middle Professional Designation Unit #
3. _________________________________________________________________
Last name, etc.
4. _________________________________________________________________
Last name, etc.
5. _________________________________________________________________
Last name, etc.
