If the Comenity website is down, you can use this temporary receipt to process a transaction. Simply complete the receipt, check and document type of identification, and have the patient sign. You can also make a copy for the patient as well. 

When the website is back up, you can process the transaction as usual, print a new receipt, and staple it to the temporary receipt in case the patient disputes the charge. 

Click here to download a temporary receipt.