Medical Invoice

Invoice Details
Date of Issue:	October 25, 2073
Invoice Number:	INV-100234
Due Date:	November 25, 2073

Billed To
Patient Name:	Talia Jacobs
Address:	Glendale, CA 91201
Phone:	222 555 7777

Services Provided
Consultation	$150.00
Total Amount Due:	$150.00

If you have any questions concerning this invoice, contact [YOUR NAME] at [YOUR EMAIL]. Thank you for your business!

Authorized Signature: ___________________
Date: October 25, 2073