Invoice #1040
Nov 4, 2026, 4:10 PM
Summary
Paid
| Item | Qty | Price | Amount |
|---|---|---|---|
| Clear aligners | 1 | $5,875.00 | $5,875.00 |
| Composite filling | 1 | $355.00 | $355.00 |
Total$6,230.00
Paid$6,230.00
Patient
Name
Email
diego.douglas@example.com
Phone
(630) 555-0128
Payment
Status
Paid
Due
Nov 18, 2026