From:

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

admin@elverdedentalbraces.vivabraces.com

Invoice Number INV-0133
Invoice Date July 10, 2019
Total Due $965.84
To:
Celyenid Suarez Colon
Hrs/Qty Service Rate/PriceAdjustSub Total
1 ORTHODONTIC $2,775.630.00%$2,775.63
Sub Total $2,775.63
Tax $0.00
Paid -$1,809.79
Total Due $965.84

Pago Manual