From:

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

admin@elverdedentalbraces.vivabraces.com

Invoice Number INV-0167
Invoice Date June 28, 2018
Total Due $119.99
To:
Daraimy Rodriguez Vega
Hrs/Qty Service Rate/PriceAdjustSub Total
1 ORTHODONTIC $2,459.630.00%$2,459.63
Sub Total $2,459.63
Tax $0.00
Paid -$2,339.64
Total Due $119.99

Pago Manual