Invoice Dentist in Russia Moscow –Free Word Template Download with AI
12/5 Tverskaya Street, Moscow, Russia, 125009
Phone: +7 (495) 123-45-67
Email: [email protected]
INN: 7701234567 | KPP: 770101001
Invoice Date: October 15, 2024
Due Date: October 30, 2024
Invoice Number: INV-2024-10-089
INVOICE Billed To:Mr. Alexander Ivanov
45 Arbat Street, Apt. 12
Moscow, Russia, 119002
Phone: +7 (916) 555-12-34
Email: [email protected]
Payment Method:Bank Transfer / Sberbank Online
Bank: Sberbank of Russia
Account: 40817810000000012345
BIC: 044525225
Correspondent Account: 30101810400000000225
| Item # | Description of Dental Services | Quantity | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 1 | Comprehensive Dental Examination and Consultation | 1 | 3,500 | 3,500 |
| 2 | Full-Mouth Panoramic X-Ray (Orthopantomogram) | 1 | 2,800 | 2,800 |
| 3 | Professional Teeth Cleaning (Ultrasonic Scaling & Air Flow) | 1 | 6,000 | 6,000 |
| 4 | Root Canal Therapy (Molar Tooth #36) | 1 | 15,000 | 15,000 |
| 5 | Composite Filling (Tooth #36) | 1 | 5,500 | 5,500 |
| 6 | Zirconia Dental Crown (Tooth #36) | 1 | 28,000 | 28,000 |
| 7 | Local Anesthesia (Per Session) | 3 | 800 | 2,400 |
| 8 | Follow-Up Visit and Crown Adjustment | 1 | 1,500 | 1,500 |
Terms and Conditions:
1. This invoice is issued in accordance with the Federal Law of the Russian Federation "On the Protection of Consumer Rights" and applicable dental service regulations in Moscow.
2. Payment is due within 15 days from the invoice date. Late payments may incur a penalty of 0.1% per day on the outstanding balance.
3. All dental procedures were performed by licensed dentists registered with the Moscow Department of Health.
4. Warranty: All restorative work (fillings, crowns) is covered by a 12-month warranty from the date of completion, provided proper oral hygiene is maintained.
5. If you have any questions regarding this invoice or your dental treatment, please contact our billing department at +7 (495) 123-45-67 or email [email protected].
6. This document serves as an official receipt for tax and insurance purposes in Russia.
Authorized Signature:
Dr. Elena Petrova
Chief Dentist
Accepted By:
_________________________
Date: ___________________
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