EFTA00314143.pdf

June 6. 2016 Dear AMERICAN MEDICAL COLLECTION AGENCY Elmsford, NY 10523 ■ COLLECTION AGENC 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. In orevu5 corresnon ence. we informed you of your obligation to pay the $814.60 you owe to our client for the following charges: 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. SERIOUSLY PAST DUE SERIOUSLY PAST DUE SEE REVERSE SIDE FOR IMPORTANT INFORMATION. Detach and return this portion with payment using enclosed envelope. To pay online: wew.pay.aincaonline.com Lim ASTLFO. Mtn UDISCCP. i Amount Due: $814.60 Card X: Exp. Date: Amount 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. I b I II I I I I I I. I Street Address: City,State Zip: . N.1 EFTA00314143