╨╧рб▒с>■  #%■   "                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴7 Ё┐Ъ bjbjUU "7|7|Ъ      l       4ъъъъ Ў4х ╢d f f f f f f $Ы ╗ vК  К ж  Я жжж  d жd ж╛жd  d   p┬▀┴tИ╚4╢ъ,jd d ╡ 0х d 1Ц1d ж44    ┘ Alliance Collection Service, Inc., УACESФ Program ACCOUNT LISTING FORM YOUR COMPANY NAME: ________________________________________________ PHONE: _______________ EMAIL: ________________________________________ DATE: ___________________ FAX:_________________________________________ ************************************************************************ Party responsible for debt: __________________________________________________ Spouse: _____________________ Account # _______________ SSN: _____________ Spouse SSN: ________________ Address: ____________________________________ City: _______________________ State: _____ Zip: _______ Phone:_______________ Employer: __________________________ City:___________ Phone: _______________ Patient name if applicable: ___________________________ DOB: _________________ Date of service: ____________________ Default date: __________________________ Cell phone numbers: ______________________________________________________ ************************************************************************ No fees may be added to your account without prior approval from agency. State usury laws apply to any fees added and proper agreement with debtor must be signed. TRUE AMOUNT DUE: $_______________________ EXPLANATION OF FEES: _______________ ________________________________________________________________________ TOTAL AMOUNT DUE: $__________________ Ъ 5JKLРС┘┌#$mn╜╛  XYкл°∙HIЩЪ¤¤¤√∙¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤Ъ ¤Ъхц/╙╘  ' ( q r Ш Щ Ъ ¤¤¤¤¤¤¤¤¤¤¤¤¤¤ 1Рh░╨/ ░р=!░"░#Ра$Ра%░ i8@ё 8 NormalCJ_HaJmH sH tH @@@ Heading 1$$@&a$ 5Б>*CJ$\Б8@8 Heading 2$$@&a$5Б\Б<A@Є б< Default Paragraph FontЪ    5JKLРС┘┌#$mn╜╛  XYкл°∙HIЩЪхц/╙╘'(qrШЩЬШ0ААШ0ААШ0АА0АА0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААШ0ААЪ0ААЪ ЪЪ Ъ ┘▀ЬжоЄ°┌ф'1u}╘╓mw╘ Ь3333333ЩЬ  Ken`C:\Documents and Settings\Ken\Application Data\Microsoft\Word\AutoRecovery save of Document1.asdKenQC:\Documents and Settings\Ken\My Documents\MISCELLANEOUS\ACCOUNT LISTING FORM.docKenQC:\Documents and Settings\Ken\My Documents\MISCELLANEOUS\ACCOUNT LISTING FORM.docKenVC:\Documents and Settings\Ken\My Documents\MISCELLANEOUS\ACCOUNT LISTING FORM ACES.docKenUC:\Documents and Settings\Ken\My Documents\ACES PROGRAM\ACCOUNT LISTING FORM ACES.docKenUC:\Documents and Settings\Ken\My Documents\ACES PROGRAM\ACCOUNT LISTING FORM ACES.docKen7P:\MARKETING\ACES Program\ACCOUNT LISTING FORM ACES.doc @А┘┘а═C--┘╘Ъ`@  Unknown            GРЗz А Times New Roman5РАSymbol3&Р Зz А Arial"ёИЁ╨hМ├&М├&з╩╣F╧Ю $Ёа┤┤ББ20л2ГЁ   Alliance Collection Service, IncKenKen■ рЕЯЄ∙OhлС+'│┘0ФШа╠╪фЁ№ ( D P \ ht|ДМф!Alliance Collection Service, IncroslliKenenen Normal.dotlKen2nMicrosoft Word 9.0 @@=1К ╟@└9иtИ╚@└9иtИ╚╧Ю■ ╒═╒Ь.УЧ+,∙о0 hp|ДМФ Ьдм┤ ╝ щф n ла !Alliance Collection Service, Inc Title ■    ■   ■    !■   ¤   $■   ■   ■                                                                                                                                                                                                                                                                                                                                                                       Root Entry         └F` т┴tИ╚&А1Table             WordDocument        "SummaryInformation(    DocumentSummaryInformation8            CompObj    jObjectPool            ` т┴tИ╚` т┴tИ╚            ■                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           ■       └FMicrosoft Word Document MSWordDocWord.Document.8Ї9▓q