Epstein Secrets

n Officer Borrower Name Name on Credit Card Credit Card Type Credit Card Number Expiration Date Amount to be charged Loan Number Joann Brown K Mastercard K Visa Borrower's Authorization Signature R eqter ed Authorization D ate Relationship to Borrower CONFIDENTIAL SIDNY_GM_00030283 EFTA_00140901

rower Name Name on Credit Card Credit Card Type Credit Card Number Expiration Date Amount to be charged Loan Number Joann Brown K Mastercard K Visa Borrower's Authorization Signature R eqter ed Authorization D ate Relationship to Borrower CONFIDENTIAL SIDNY_GM_00030283 EFTA_00140901 EFTA01

il Relationship to Patient friend Payment Amount Indicate type of credit card to be charged (We do not accept Debit Cards) IRl American Express K Mastercard K Visa K Diners Club K Discover Credit Card Number Exp. Date CVN Cardholder's Information: Me Address where the credit card statements are

ip to Patient friend Payment Amount Indicate type of credit card to be charged (We do not accept Debit Cards) IRl American Express K Mastercard K Visa K Diners Club K Discover Credit Card Number Exp. Date CVN Cardholder's Information: Me Address where the credit card statements are mailed)

Referring Name Accession 10/14/20157:30 AM EDT MRLSPNI MOSKOWITZ, BRUCE W, M.D 6784742 PAYMENT IS DUE AT THE TIME OF SERVICE K Cash K Check K Mastercard K Visa K Amex K Discover I HEREBY ACKNOWLEDGE THAT I AM FULLY RESPONSIBLE FOR ANY UNPAID BALANCES. Signature of Patient or Guardian: £LLbh£LZLZ

me Accession 10/14/20157:30 AM EDT MRLSPNI MOSKOWITZ, BRUCE W, M.D 6784742 PAYMENT IS DUE AT THE TIME OF SERVICE K Cash K Check K Mastercard K Visa K Amex K Discover I HEREBY ACKNOWLEDGE THAT I AM FULLY RESPONSIBLE FOR ANY UNPAID BALANCES. Signature of Patient or Guardian: £LLbh£LZLZ 643etal

ayer Relationship to Patient friend Payment Amount Indicate type of credit card to be charged (We do not accept Debit Cards) Z American Express K Mastercard K Visa K Diners Club K Discover Credit Card Number Exp. Date 05/16 CVN 9129 'Cardholder's Information: (The Address where the credit card st

ship to Patient friend Payment Amount Indicate type of credit card to be charged (We do not accept Debit Cards) Z American Express K Mastercard K Visa K Diners Club K Discover Credit Card Number Exp. Date 05/16 CVN 9129 'Cardholder's Information: (The Address where the credit card statements