Third Party Code

Required. Enter the third party which assumes payments for the customers on which it is selected.

Corporation Name

Conditional. Required if Individual Name is not entered. If the party billed is a company or government, enter the customer name in this field.

Not allowed otherwise.

Individual Name (Last, First, MI)

Conditional. Required if Corporation Name is not entered. Enter the last name, first name, and middle initial of the third party if they are an individual.

Not allowed otherwise.

Division Name

Optional. Enter the company division, department or other additional name information.

Address, City, State, Zip

Required. Enter the third party street address, city, state and zip code. The first five digits of the zip code are required and the last four optional (these default to spaces).

Phone Number

Optional. Enter the third party's telephone number.

Fax Phone

Optional. Enter the telephone number for the third party's fax machine.

Mail Returned

Default is No Entry [N] . Select Yes [Y] to identify third party billing addresses that are no longer valid.