EFTA00313297.pdf

STATEMENT Thomas J. Magnani D.D.S. Telephone: Alvin Grayson D.D.S. 7 West 51st Street L 'Peri by ere ninnt man lie mount yw we pa In IN /eminence box and Iii out taw 7th Floor Msitercard Mu Pax New York NY 10019 Card* Ey Ca Scram till Code Date Account 11/27/2013 9648 RS* IMPORTANT. PLEASE DETACH UPPER PORTION MID RETURN WITH YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges I Credits Balance —I 10/31/2013 Previous Balance 220.00 0 a£'.'u 01446 Account Total 220.00 You have probably overlooked this statement. Your remittance would be appreciated. We accept credit cards You may complete and return the top part of this statement, or call the office al Current 30 Days 60 Days 90 Days 120+ Days 0.00 220.00 0.00 0.00 0.00 Thomas J. Magnani D.D.S. Alvin Grayson D D S 7 West 51St Street 7th Floor New York NY 10019 EFTA00313297