REQUIRO SCIENTIA LLC FIFTH THIRD BANK == PALM BEACH, FL 33480 63-9171/670 j § PAY TO THE i ORDER OF___Blue Cross Blue Shield = ___. $ 1,040.88 | is) oe ene E TERN E TERE EERE EEE EE EES EE EEE ES EERE EEE EEE E EROS EEE EEE EEE EOR® DOLLARS Blue Cross Blue Shield PO Box 538660 ‘ Atlanta, GA 30353-8660 EFTA00273029

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CREDIT ACCT OF NAMED PAYE: ENDORSEMENT, GUARANTEED BY BB&T CHARLOTTE NC EFTA00273030