7560
SEQUIN° SCIENT1A LLC FIFTH THIRD BANK
NAM BFACH. r13300 639171/670
04/06/18
WWTOTHE
onDER OF Blue Cross Blue Shield - $•'2,199.52
IMMIMPOWMHS*Altirsamit
Two Thousand One Hundred Ninety-Nine and S2/1.00******************
Blue Cross Blue Shield la? twa,
PO Box 538660 iCA :
Atlanta, GA 30353-8660
4:1FrObli
E
MEMO
EFTA00273103
7
v;
•
CREDIT ACCT OF NAMED PAYEE
ENDORSEMENT GUARANTEEDBY BUT CHARLOTTE NC
EFTA00273104