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