From:

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

admin@elverdedentalbraces.vivabraces.com

Invoice Number INV-0173
Invoice Date October 4, 2018
Total Due $0.00
To:
Dayana M. Felix Zayas
Hrs/Qty Service Rate/PriceAdjustSub Total
1 BROKEN BRACKETS $20.000.00%$20.00
Sub Total $20.00
Tax $0.00
Paid -$20.00
Total Due $0.00

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