TAX INVOICE
Address : 15 Hodges Mews, High Wycombe HP12 3JL, United Kingdom.
Original For Recipient
Dreams Medicals
Patient Information
Patient Name :
Patient Birth Date :
Insurance Billed :
Patient No :
Micle Richard
32 Years Old - 22 July 1991
WPS
123456789
Service :
Due Date :
Address :
Dental Treatment
25 Jan 2024
4 Balmy Beach Road, Owen Sound, Ontario, Canada
| # | Item | Price | Qty | Total |
|---|---|---|---|---|
| 1 | Dental Treatment | $350 | 1 | $350 |
| 2 | Bed Charge | $600 | 1 | $600 |
| 3 | Consultant Surgeon Fee | $200 | 2 | $400 |
| 4 | Nursing Service Charge | $100 | 3 | $300 |
| 5 | Medical Hospital Supply | $100 | 3 | $300 |
| 6 | Dental Treatment | $100 | 3 | $300 |
| Taxable Amount | $1650.00 | |||
| IGST 18.0% | $165.00 | |||
| Total Items / Qty : 6 / 6.00 | Total | $1,815.00 | ||
Total amount ( in words): One Thousand Eight Hundred Fifteen Dollars Only.
Payment Info :
Debit Card : 465 *************645
Amount : $1,815
Terms & Conditions :
1. Goods Once sold cannot be taken back or exchanged.
2. We are not the manufactures, company will stand for warrenty as per their terms and conditions.
Thanks for your Business