Supplemental document statement for VA form 10-2501

The attached supplemental document, VA form 10-2501, Prosthetic Service Card, is prepopulated by Prosthetic Services. The Veteran will only have to sign their name. This
card is used in conjuction with VA Form 10-2520, Prosthetic Service Card Invoice. It is
used by the vendor as an invoice and billing document. The original invoice and one
copy of the form are forwarded to the VAMC indicated on the Prosthetic Service Card.
By presenting the Service Card 10-2501 with I.D., the Veteran described may obtain
repairs or replacement parts. Invoices will not be paid unless the Veteran’s name, last
four of social security number, serial number and the certification shown on the Service
Card 10-2501, are clearly written or typed on the face of the company’s standard
invoice.