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2024-08-13T19:58:02+00:00
Information Request
Automated Business Systems looks forward to working with you!
Please provide us with the requested information so we can begin having productive discussions about how ABS can be an integral part of your team
Name
First
Last
Name of Practice
Email
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Website
What were your average receipts for the prior year?
What is your specialty?
How many patients do you see per day ?
What are your current accounts receivable?
30 Days
31-60 Days
61-90 Days
91-120 Days
120+ Days
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