R3VDESIGN Service Invoice
Issue Date: 10/13/2010
PO: 1355NNB29700 Invoice #: OMSD0002
Invoice Amount: $ 2,217.25
Please submit payments to: CUSTOMER
Tony Thai UCLA Oral Surgery
R3V Design 10833 Le Conte Ave.
11237 Riveroak Street CHS A0-156
Corona, CA 92883 Los Angeles, CA 90095
Phone: (951) 667-5851
billing@r3v-design.net
LINE DESCRIPTION Unit Unit Cost TOTAL
1 Charge Capture 9.5 35.00 $ 332.50
2 System Stress Test 14 35.00 $ 490.00
3 Inventory Systems Development 10 35.00 $ 350.00
4 Electronic Authorization Resolution 12.6 35.00 $ 441.00
5 Insurance e-claim Processing 17.25 35.00 $ 603.75
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
SUBTOTAL $ 2,217.25
TAX RATE $ -
SALES TAX $ -
SHIPPING AND HANDLING $ -
TOTAL $ 2,217.25
The above is an itemized summary report for the invoice services and dates indicated.
If you have any questions concerning this invoice, contact billing: infobill@r3v-design.net
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