Invoice

From:

P.O. Box 848
Hamburg, NY 14075

Invoice Number INV-INV-0601
Invoice Date December 1, 2017
Due Date January 1, 2018
Total Due $199.00
To:
Paul M. Chlosta, D.M.D.

3040 Amsdell Road, Suite 203
Hamburg, NY 14075

Level 1 Renewal

Hrs/Qty Service Rate/PriceAdjustSub Total
1 Membership Renewal Invoice

Level 1 Renewal

$199.000.00%$199.00
Sub Total $199.00
Tax $0.00
Total Due $199.00