Epstein Secrets

account balance using a credit card this month, or to change your billing address. Name (as ;1 appears on the carte Type of card (cneck one) • • American Express [ Discover : MasterCard Visa Account Number Credit Card Billing Zip Code Expiration date — Month Year Amount $ Signature Company Name

LIMITED Account number 747607414 Statement date May 15.2004 Billing period April 11 - May 10, 2004 Additional Account Information iPayments to Previous Balance pd 2..43..9 Payment 05/10/04 -953.74 Total Payments to Previous Balance -$953.74 Misc. Additional Charge Summary Owes Nile Man Total Misc.

N ZORRO MANAGEMENT LLC 9E 71ST ST NEW YORK NY 10021-4102 Check here if your address or phone number has changed. Note changes on reverse side. AMERICAN EXPRESS P.O. BOX 1270 NEWARK NJ 07101-1270 00003499921421965185 005211907000521190 07 rl Account Ending 0-01009 Enter 15 digit account ft on all payment

ayment Options this Month Include: Total Early Pay Discount To Date As of 09/10/19 $15,112.36 Early Pay Account Summary New Balance $3,724.03 Previous Balance $3,869115 Early Pay Due Date 09/20/19 Payments/Credits indudesEattyPayDiscount of -BM -$145.83 NewCharges +$900 Defer Pay-Suspended Fees +

2/17/2014 Bite Wings 4 Films 65.00 635.00 1/8/2015 Panoramic Film 0,00 635.00 1/8/2015 Ortho treatment adult 7,500.00 8,135.00 1/30/2015 AMERICAN EXPRESS 635.00 7,500.00 2/9/2015 1 Periapical X Ray 25.00 7,525.00 Account Total 7,526.00 Patient Charges 8,160.00 Patient Payments 636.00- Patie

UPPER PORT )N MD RETURN WiTI- YOUR io MITTA *CC TO u. UAL CRC CO TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 6/20/2014 Previous Balance 0.00 12/17/2014 Amalgam 2 Surface Perm. 350.00 350.00 12/17/2014 Recall Oral Exam 40.00 390.00 12/17/2014 Adult Scale & Prophy 180.00 57