Payment Plan Amount

{{othersList.installmentRecords.selectedOption.TotalScheduledAmount|currency}}

Payment method :{{"ACH"==othersList.installmentRecords.CardData.PaymentType?"Electronic Check":"CC"==othersList.installmentRecords.CardData.PaymentType?"Credit Card ":othersList.installmentRecords.CardData.PaymentType}} {{othersList.installmentRecords.CardData.formattedCard}}

Frequency

No. of Installments

Email Address

First Payment Date

Patient	Responsible Party	Account #	Date of Service	Balance	Scheduled Payment

Sl No.	Scheduled Date	Amount
	{{sub.ScheduledDate\|date:'MM/dd/yyyy'}} (Down Payment)

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Please accept the terms and conditions

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