Free Medical Payment Receipt Template
Medical Payment Receipt
Bill To: Sigmund Corwin
Address: Seattle, WA 98101
Email: sigmund@you.mail
|
Description |
Amount |
|---|---|
|
Consultation Fee |
$150.00 |
|
X-Ray |
$200.00 |
|
Total |
$350.00 |
Payment Method: Credit Card, [YOUR COMPANY NAME]
Card Number: 12 3456 7890 1234
Expiration Date: 12/80
Thank you for your payment!
Signature: ______________________________
[YOUR NAME]
