From:

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

admin@elverdedentalbraces.vivabraces.com

Invoice Number INV-0168
Invoice Date August 16, 2018
Total Due $419.93
To:
Darieliz Pizarro Mulero
Hrs/Qty Service Rate/PriceAdjustSub Total
1 ORTHODONTIC $2,459.630.00%$2,459.63
Sub Total $2,459.63
Tax $0.00
Paid -$2,039.70
Total Due $419.93

Pago Manual