Douglasville Medicine Associates
	5076 Brand Blvd., Suite 401
	Douglasville, NY  01234
	Ph: (123) 456-7890
	 Fax: (123) 456-7891
	Email: admin@dfma.com
	Website: www.dfma.com
EUGENE SYKES	Date:	03/25/2013
5201 Marble Way	Account No:	SYK001
Douglasville, NY  01235	Student No:	Your name
SUBJECT:  SERVICE DATES 10/16/2009 AND 11/02/2009 – BALANCE DUE $300.00
Dear Mr. Sykes:

On several dates over the past year, we called your attention to your account balance in the amount of $300.00.
According to our records, we have not received a response from you.  As you know, at the time you received services, your insurance coverage had lapsed and resulted in none of the service charges being paid.  
We extended credit to you on your account in good faith and expected payment under our normal terms, which we feel are most reasonable, given the amount of time that has passed.
So that no further action on our part will be necessary, we shall expect payment within five days of receipt of this letter or the courtesy of reply to our letter as to why payment is being withheld. If we do not receive any response from you, I will be forced to turn your account over to our collection agency, Northern Recovery Services, Inc.  Thank you for your prompt attention to this matter.
Sincerely yours,

Jackie Simmons, CMA
Office Manager

Your initials

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