Financial Services -
  Unrestricted Accounting & Reporting

Hospital Invoicing

Contact Information

Name: *
Email Address:
  (i.e. jdoe@salud.unm.edu)		 *
Department:
Telephone:
Invoice Type
Amount to be Charged:
Index for Revenue
(6 characters):
Account Code for Revenue
(4 characters):
Description of Charges
(30 characters):
Support Documentation
To Follow:
Comments/Special Instructions:
Please print this form out before you hit "Submit" for your own records.

* - Required Fields