EFTA00314143.pdf

AMERICAN MEDICAL COLLECTION AGENCY COLLECTION AGENC Elmsford, NY 10523 SERIOUSLY PAST DUE ■ You may contact Joseph Howard at the phone number above. It Mr. Howard is unavailable, another representative will answer your call to assist you between the hours of 8:30AM - 8PM Mon. - Fn. June 6. 2016 Dear In orevu5 corresnon ence. we informed you of your obligation to pay the $814.60 you owe to our client for the following charges: SERIOUSLY PAST DUE Date of Service Account Number Jlance 5814.60 The amount of money involved is $814.60. If you have insurance. we will not accept your claim form. It is your responsibility to make full payment. Any insurance claim is your responsibility to negotiate with your carrier. Mail your payment to us with the bottom of this letter. SEE REVERSE SIDE FOR IMPORTANT INFORMATION. Detach and return this portion with payment using enclosed envelope. i Amount Due: $814.60 To pay online: wew.pay.aincaonline.com Card X: Exp. Date: Lim ASTLFO. Mtn Amount UDISCCP. You Owe: Signature: Client Code: Account_ Charge Date SEE ABOVE Pin Nvmbe• Account Number Pin Number Name: 1,hill I g I u I I " I I I I I 9.Ib III II III I. I Street Address: City,State Zip: . N.1 EFTA00314143