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CHECK ACCEPTANCE NOTIFICATION

Dear Patient:

Your check payment information will be put through the edits and the payment will be applied to the appropriate account if it is accepted by our processor.

Please note that on your check statement the name of PLEXUS will appear. We are the billing agency for Doctor and process all payments. Please do not dispute this charge.

***This serves as notification that if your check is returned for any reason there will be a $35 fee. If you have any questions on this issue please do not hesitate to contact us at 262-654-5555. Thank you.***

By clicking on the Continue button below, you electronically agree to the terms listed above.

In the next step, please insert your account number in the invoice field and doctor's name in the company field.

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