EFTA00603935.pdf

STATEMENT Thomas J. Magnani D.D.S. Telephone: Alvin Grayson D.D.S. 7 West 51st Street psr by am6I net ONE Me PaHunl pep VP mimeses somPlarms box ad • PA blow 7th Floor MaplaimA Ws Oa New York NY 10019 Ceti Ea OS Oman MEOW Jeff Epstein Date Account 9 East 71st Street 1126/2014 New York NY 10021 Remittance IMPORTANT - PLEASE DETACH UPPER PORTON NC REMAIN VAT/4 YOUR RENOUNCE TO INSURE CREDIT TO PROPER ACCOUIIT Date Patient Description Charges Credits Balance Pout". %/1 km eatift, r loiticipi{ 7442cscot Account Total If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete a top part of this statement, or call the office a1 Current 30 Days 60 Days 90 Days T — 120+ Days 0.00 0.00 0.00 ,i 0.00 Thomas J. ItagnaM O.D.S. AMn Grayson D.O.S. 7 West Slat Street 7th Floor New York NY 10019 EFTA00603935  STATEMENT Thomas J. Magnani D.D.S. Telephone: Alvin Grayson D.D.S. 7 West 51st Street payag by ma owe. nuer en 'moat yen aro pornFM teniuma boy are1 out bekw. 7th Floor Iniskand V10 Amu New York NY 10019 Ord • bp Dna SIgnobse SKI Can Jeff Epstein Date 9 East 71st Street 6/3/2015 New York NY 10021 Remelenom SIPORTANT . RAMC MACH UPPER PORTIONMO MOURN NTH YOUR REMITTANCI TO MUM CREPT TOPROM ACCOUNT Date Patient Description Charges Credits Balance s. 3 pou9 0,4v Account Total If payment has been sent, please disregard this statement - Thank You. We accept credit cards! You may complete top part of this statement, or call the office a Current 30 Days 60 Days 90 Days 120+ Days 0.00 0.00 0.00 0.00 Thomas J. Magnani O.D.S. AMa Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603936  STATEMENT Thomas J. Magnani D.D.S. Telephone Alvin Grayson D.D.S. 7 West 61st Street soya,' by alai ma Nam Pa moat yet ars ay" in MT ranitina tat aid OW Dana 7th Floor Nalstatd Afiter/ New York NY 10019 Ord Hl Omar soave so Cost Jeff Epstein Date 9 East 71st Street 9/30/2015 p New York NY 10021 Renton* A4PORTANT • PLEAS( DETACH UPPER PORTIONMO RETURN VATH YOUR REISTTNK€ TO INSVII5 MOTT 10 PROPER ACCOUNT Date Patient Description Charges Credits Balance Account Total If payment has been sent, please disregard this statement - Thank You. We accept credit cards! You may complete top part of this statement, or call the office at i Current 30 Days 60 Days 90 Days 120+ Days 0.00 0.00 0.00 0.00 Thomas J. Magner)] D.O.S. Alvin Grayson D.O.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603937  STATEMENT Thomas J. Magnani D.D.S. Telephone: Alvin Grayson D.O.S. 7 West 51st Street pan by nal tent car Na aTa.ni m dm Panrqn Ra annOnc• box rd oul twcw, 7th Floor Maaanorti Va. Amu New York NY 10019 Cad• EipOW &amour, N2 Code Jeff Epstein Date Account 9 East 71st Street 10/29/2015 M New York NY 10021 Remittance IMPORTANT • PLEASE DETACH UPPER PORTION MO RETURN Will YOUR RFJaITANCE TO INSURE CREOR TO PROPERACCOUNT Date Patient Description Charges Credits Balance Account Total 3,525.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete top part of this statement, or call the office at Current 30 Days 60 Days 90 Days 120+ Days 0.00 0.00 0.00 0.00 Thomas J. Magnari D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603938  HISTORICAL STATEMENT 1/5/2016 to 2/24/2016 Thomas J. Magnani D.D.S. TelephoneMIM Alvin Grayson D.D.S. 7 West 61st Street 7th Floor New York NY 10019 Jeff Epstein Date 9 East 71st Street 2/24/2016 New York NY 10021 Rometanoe IMPORTANT PLEASE (DETACH UPPER PORTION AND RETURN IM111 YOUR RETATTANCE TO INSURE ClcsOR TO PROPER ACCOUNT Date Patient Description Charges Credits Balance Account Total 0.00 Patient Charges Patient Payments Patient Credits 0.00 Patient Debits 0.00 We accept credit cards You may complete top part of this statement, or call the office atill. Current 30 Days 60 Days 90 Days 120+ Days 0.00 0.00 0.00 0.00 0.00 Thomas .1. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603939  STATEMENT Thomas J. Magnani D.D.S. Telephone: Alvin Grayson D.D.S. 7 West 61st Street I payee by Groat cad. Filet tie amount you en WAD IA me recalaRta OP[ Si IS out bad/. 7th Floor APAstarad %Ma Nati New York NY 10019 Calf I gip Da Drain Ski Coar Jeff Epstein Oate 9 East 71st Street New York NY 10021 3/30/2016 p Ramat:ince alPONTAN1 • PLEASE DETACH UPPUR POIItO'J N40 RUT LAIN WIN YOUR HEHATTNCE TO ENSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance Account Total If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete top part of this statement, or call the office at . Current 30 Days 60 Days 90 Days 120« Days 0.00 0.00 0.00 0.00 Thomas J. Magnanl D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603940