ACCOUNTING SUBMISSION FORM

Notice to Accounting Form

Complete this form to notify accounting if you will be completing a debit transaction or series of transactions totaling $5,000 or more in a day. Examples of this would be a Patient Credit Card Refund, a Patient Care Credit or other Finance Refund, or a large ACH/Debit card office purchase.

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If you have questions or difficulty using the form, please email asmith@gps.dental