Sample Account Statement
Service Address
Next statement date
Account number
Total of last
account
Processed since
last account
Balance brought
forward
New
charges
NewWorld Company
PIONEER VALLEY REGION
☎ 999 9999 − ACCOUNT ENQUIRIES 8:30AM TO 4:30PM
☎ 999 8888 − SERVICE ENQUIRIES 8:00AM TO 5:00PM
PAYMENT SLIP
Automatic Account Payment:
to apply contact 999 9999or any New World Store.
Paying by Mail:
Detach this payment slip.
Make checks out to: NewWorld Medical Association.
In Person:
Present this account intact at your
local NewWorld Store
Please do not pin or staple check to payment slip.
Mail both to: GPO BOX 100, Globecity 1000.
Total amount due
+ =
3035[MV−7]
NOTE: This is not a bill, just a recap of your account. If you wish to make a payment, please use the payment slip below.
DATE:__________________
STATEMENT
544SI
$
Acct. No.
Over 90 Days61−90 Days31−60 Days1−30 DaysCurrent
$43.95$0.00$0.00$0.00$0.00
544SI
IS00126630 19−MAY−04 Invoice 18−JUN−04 ICABR2926
PART NUMBER DESCRIPTION/DETAIL REFERENCE
HURLBURT
131 LOOP ROAD BLDG 91042
HURLBURT FL 32544
16TH STREET MEDICAL GROUP : FIELDBT1
131 LOOP ROAD BLDG 91042
HURLBURT FL 32544
544SI
−JAN−05
$43.95
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