From:

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

admin@elverdedentalbraces.vivabraces.com

Invoice Number INV-0050
Invoice Date May 30, 2018
Total Due $119.98
To:
Ana S. Cruz Hidalgo
Hrs/Qty Service Rate/PriceAdjustSub Total
1 ORTHODONTIC $2,459.630.00%$2,459.63
Sub Total $2,459.63
Tax $0.00
Paid -$2,339.65
Total Due $119.98

Pago Manual