From:

Suite 5A-1204
123 Somewhere Street
Your City AZ 12345

admin@elverdedentalbraces.vivabraces.com

Invoice Number INV-0021
Invoice Date February 19, 2020
Total Due $923.93
To:
Alexa De Mar Cruz Jimenez
Hrs/Qty Service Rate/PriceAdjustSub Total
1 ORTHODONTIC $2,775.810.00%$2,775.81
Sub Total $2,775.81
Tax $0.00
Paid -$1,851.88
Total Due $923.93

Pago Manual