Invoice

Invoice No: #745664

Date: 22/03/2023

Invoice To:
Alex Farnandes
450 E 96th St, Indianapolis,
WRHX+8Q IN 46240,
United States
Invar Hospital:
4510 E 96th St, Indianapolis,
IN 46240, Inoba, Austona
info@Invarhospital.com
+153 6547 3698

Patient Information:

Patiend Name:Alex FarnandesPatient ID:123456789
Patient Age:35 YearsService:Blood Test
Due Date:27/07/2022Insurence Billed:WPS
Address:4 Balmy Beach Road, Owen Sound, Ontario, Canada
DetailsPriceTaxAmount
Blood Test$250.0010%$275.00
Test Kit$15.002%$15.30
Consultant Surgeon Fee$20.000%$20.00
Medical Hospital Supply$25.000%$25.00
Nursing Service Charge$30.000%$330.00
Total Amount:$365.30
Payment Info:

Credit Card No: 2456**********
A/C Name: Alex Farnandes

Paid:$545.00
Balance Due:$00.00

Invar Inc:
12th Floor, Plot No.5, IFIC Bank, Gausin Rod, Suite 250-20, Franchisco USA 2022.

NOTE: This is computer generated receipt and does not require physical signature.