Get Third Party Billing Form - Adventist University Of Health Sciences

This guide provides clear instructions on how to effectively complete the Third Party Billing Form for Adventist University Of Health Sciences. Understanding each section will ensure that your tuition billing process is seamless and efficient.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the document and open it for editing.
2. Begin with the 'Student Information' section. Please print or type your name, student ID, date, address, city, state, and zip code. Ensure all information is accurate.
3. Next, provide your email address and daytime phone number. This contact information is essential for correspondence regarding your billing.
4. Select your program from the available options. Check the box for ‘Online Bachelor of Science in Nursing’, ‘Online Bachelor of Science in Radiologic Sciences’, or ‘Online Bachelor of Science in Diagnostic Medical Sonography’ as applicable.
5. Indicate the semester you are enrolling in by checking one of the options: Fall, Spring, or Summer.
6. Enter your course number, course name, and course dates. This information is vital for accurate billing.
7. Fill in the matriculation fee and total cost of textbooks. Then, calculate and state the total cost.
8. Specify the amount authorized to be paid by your employer. This amount should align with the tuition remission policy of your employer.
9. An authorized representative from your company must print their name, sign, and provide their title and telephone number.
10. Complete the billing address for the employer, ensuring that the city, state, and zip code are included.
11. A credit card authorization section is included. Circle the type of card (MC, VISA, DISCOVER, AMEX) and provide the credit card number, name on the card, expiration date, and signature.
12. Indicate whether you prefer restricted or unrestricted billing by checking the appropriate box.
13. If applicable, provide details for educational subsidy, vocational rehabilitation, or any other third party billing information not previously listed, including organization name, address, contact name, and phone number.
14. Once all sections have been filled out accurately, save your changes. You may also download, print, or share the form as needed.

Complete your Third Party Billing Form online to ensure timely processing of your tuition payments.