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Patient Id: Patient Name: Invoice Date Jask Dental Clinic Address Line 1 Address Line 2 City, State - Zipcode Country Abc0001 123456 09/26/2012

This document is an invoice from JASK Dental Clinic dated September 26, 2012. It contains details of 100 items provided to patient ABC0001, including item numbers, descriptions, quantities, prices and extended prices. The total amount due is not stated but can be calculated from the extended prices listed for each item.

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swayambhu000
Copyright
© © All Rights Reserved
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77 views3 pages

Patient Id: Patient Name: Invoice Date Jask Dental Clinic Address Line 1 Address Line 2 City, State - Zipcode Country Abc0001 123456 09/26/2012

This document is an invoice from JASK Dental Clinic dated September 26, 2012. It contains details of 100 items provided to patient ABC0001, including item numbers, descriptions, quantities, prices and extended prices. The total amount due is not stated but can be calculated from the extended prices listed for each item.

Uploaded by

swayambhu000
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

JASK Dental Clinic

Patient ID:

ABC0001

Address Line 1
Address Line 2

Patient Name: 123456

City, State - ZipCode

Invoice Date

09/26/2012

Country

Qty

Item Number

Item Description

Price

Ext Price

1 ITEM1

Product Description - SIZE 1

1.17

1.17

2 ITEM2

Product Description - SIZE 2

9.86

19.72

3 ITEM3

Product Description - SIZE 3

9.34

28.02

4 ITEM4

Product Description - SIZE 4

7.13

28.52

5 ITEM5

Product Description - SIZE 5

2.05

10.25

6 ITEM6

Product Description - SIZE 6

0.89

5.34

7 ITEM7

Product Description - SIZE 7

3.54

24.78

8 ITEM8

Product Description - SIZE 8

1.55

12.40

9 ITEM9

Product Description - SIZE 9

3.26

29.34

10 ITEM10

Product Description - SIZE 10

3.63

36.30

11 ITEM11

Product Description - SIZE 11

9.12

100.32

12 ITEM12

Product Description - SIZE 12

8.61

103.32

13 ITEM13

Product Description - SIZE 13

8.50

110.50

14 ITEM14

Product Description - SIZE 14

7.84

109.76

15 ITEM15

Product Description - SIZE 15

0.79

11.85

16 ITEM16

Product Description - SIZE 16

7.57

121.12

17 ITEM17

Product Description - SIZE 17

3.83

65.11

18 ITEM18

Product Description - SIZE 18

2.56

46.08

19 ITEM19

Product Description - SIZE 19

3.18

60.42

20 ITEM20

Product Description - SIZE 20

3.11

62.20

21 ITEM21

Product Description - SIZE 21

9.30

195.30

22 ITEM22

Product Description - SIZE 22

5.71

125.62

23 ITEM23

Product Description - SIZE 23

6.64

152.72

24 ITEM24

Product Description - SIZE 24

3.08

73.92

25 ITEM25

Product Description - SIZE 25

2.28

57.00

26 ITEM26

Product Description - SIZE 26

3.37

87.62

27 ITEM27

Product Description - SIZE 27

0.91

24.57

28 ITEM28

Product Description - SIZE 28

1.90

53.20

29 ITEM29

Product Description - SIZE 29

0.35

10.15

30 ITEM30

Product Description - SIZE 30

5.42

162.60

31 ITEM31

Product Description - SIZE 31

5.08

157.48

32 ITEM32

Product Description - SIZE 32

7.65

244.80

33 ITEM33

Product Description - SIZE 33

9.32

307.56

34 ITEM34

Product Description - SIZE 34

4.10

139.40

35 ITEM35

Product Description - SIZE 35

8.87

310.45

36 ITEM36

Product Description - SIZE 36

1.67

60.12

37 ITEM37

Product Description - SIZE 37

0.02

0.74

38 ITEM38

Product Description - SIZE 38

6.53

248.14

Page No. 1

JASK Dental Clinic

Patient ID:

ABC0001

Address Line 1
Address Line 2

Patient Name: 123456

City, State - ZipCode

Invoice Date

09/26/2012

Country

Qty

Item Number

Item Description

Price

Ext Price

39 ITEM39

Product Description - SIZE 39

3.21

125.19

40 ITEM40

Product Description - SIZE 40

9.83

393.20

41 ITEM41

Product Description - SIZE 41

7.73

316.93

42 ITEM42

Product Description - SIZE 42

0.38

15.96

43 ITEM43

Product Description - SIZE 43

7.84

337.12

44 ITEM44

Product Description - SIZE 44

3.35

147.40

45 ITEM45

Product Description - SIZE 45

0.12

5.40

46 ITEM46

Product Description - SIZE 46

4.52

207.92

47 ITEM47

Product Description - SIZE 47

9.91

465.77

48 ITEM48

Product Description - SIZE 48

5.64

270.72

49 ITEM49

Product Description - SIZE 49

2.25

110.25

50 ITEM50

Product Description - SIZE 50

2.56

128.00

51 ITEM51

Product Description - SIZE 51

0.15

7.65

52 ITEM52

Product Description - SIZE 52

8.53

443.56

53 ITEM53

Product Description - SIZE 53

2.58

136.74

54 ITEM54

Product Description - SIZE 54

8.18

441.72

55 ITEM55

Product Description - SIZE 55

2.89

158.95

56 ITEM56

Product Description - SIZE 56

7.80

436.80

57 ITEM57

Product Description - SIZE 57

9.97

568.29

58 ITEM58

Product Description - SIZE 58

5.29

306.82

59 ITEM59

Product Description - SIZE 59

1.66

97.94

60 ITEM60

Product Description - SIZE 60

3.16

189.60

61 ITEM61

Product Description - SIZE 61

9.56

583.16

62 ITEM62

Product Description - SIZE 62

5.00

310.00

63 ITEM63

Product Description - SIZE 63

4.95

311.85

64 ITEM64

Product Description - SIZE 64

2.16

138.24

65 ITEM65

Product Description - SIZE 65

5.28

343.20

66 ITEM66

Product Description - SIZE 66

3.95

260.70

67 ITEM67

Product Description - SIZE 67

5.58

373.86

68 ITEM68

Product Description - SIZE 68

1.27

86.36

69 ITEM69

Product Description - SIZE 69

7.28

502.32

70 ITEM70

Product Description - SIZE 70

5.30

371.00

71 ITEM71

Product Description - SIZE 71

2.71

192.41

72 ITEM72

Product Description - SIZE 72

9.72

699.84

73 ITEM73

Product Description - SIZE 73

5.71

416.83

74 ITEM74

Product Description - SIZE 74

4.67

345.58

75 ITEM75

Product Description - SIZE 75

7.70

577.50

76 ITEM76

Product Description - SIZE 76

3.21

243.96

Page No. 2

JASK Dental Clinic

Patient ID:

ABC0001

Address Line 1
Address Line 2

Patient Name: 123456

City, State - ZipCode

Invoice Date

09/26/2012

Country

Qty

Item Number

Item Description

Price

Ext Price

77 ITEM77

Product Description - SIZE 77

6.12

471.24

78 ITEM78

Product Description - SIZE 78

7.93

618.54

79 ITEM79

Product Description - SIZE 79

3.80

300.20

80 ITEM80

Product Description - SIZE 80

5.60

448.00

81 ITEM81

Product Description - SIZE 81

7.62

617.22

82 ITEM82

Product Description - SIZE 82

7.09

581.38

83 ITEM83

Product Description - SIZE 83

4.96

411.68

84 ITEM84

Product Description - SIZE 84

6.07

509.88

85 ITEM85

Product Description - SIZE 85

2.32

197.20

86 ITEM86

Product Description - SIZE 86

3.07

264.02

87 ITEM87

Product Description - SIZE 87

0.61

53.07

88 ITEM88

Product Description - SIZE 88

8.34

733.92

89 ITEM89

Product Description - SIZE 89

3.30

293.70

90 ITEM90

Product Description - SIZE 90

1.74

156.60

91 ITEM91

Product Description - SIZE 91

2.18

198.38

92 ITEM92

Product Description - SIZE 92

6.07

558.44

93 ITEM93

Product Description - SIZE 93

8.92

829.56

94 ITEM94

Product Description - SIZE 94

0.25

23.50

95 ITEM95

Product Description - SIZE 95

1.58

150.10

96 ITEM96

Product Description - SIZE 96

5.91

567.36

97 ITEM97

Product Description - SIZE 97

3.27

317.19

98 ITEM98

Product Description - SIZE 98

6.28

615.44

99 ITEM99

Product Description - SIZE 99

3.75

371.25

100 ITEM100

Product Description - SIZE 100

5.22

522.00

Page No. 3

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