Epstein File EFTA00310257: East 71st and Submission (DS9)

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Epstein File EFTA00310257: East 71st and Submission (DS9)

Financial RecordDate unavailableEFTA003102571 keyword hits

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This document is a credit card application or account form for an individual account at 9 East 71st Street, New York, New York 10021, with account number 3767 658400 13001 and expiration date 8/14. The form includes contact information with phone number 212-750-9895 and fax number 340-775-2525, and requests submission by fax to 340-693-3839.

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East 71st submission 9 East 71st Street

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type: Individual (personal credit card) Corporate Company Name: Account number: 3767 658400 13001 Exp. date: 8/14 Address: (where national # mailed) 9 **East**

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**71st** Street City, State and Zip: New York, New York 10021 Phone number: 212-750-9895 Fax or alternate number: 340-775-2525 Guest Information Guest name

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We ask you to please sign and date the form before **submission**. Please fax the completed form to 340-693-3839.