Invoice Optometrist in Russia Saint Petersburg –Free Word Template Download with AI
19th Line, Vasilievsky Island, House 42, Office 305
Saint Petersburg, Russia, 199178
Tel: +7 (812) 555-01-99 | Email: [email protected]
INN: 7805123456 | KPP: 780501001
Date: October 24, 2023
Due Date: November 07, 2023
Bill To:
Alexei Petrov
Individual Consumer
Nevsky Prospect, 120, Apt 45
Saint Petersburg, Russia, 191025
Phone: +7 (921) 123-45-67
| # | Description of Optometry Services | Quantity | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 1 |
Comprehensive Refraction Analysis Detailed assessment of visual acuity and refractive error using automated and manual techniques. |
1 | 3,500.00 | 3,500.00 |
| 2 |
Binocular Vision Assessment Evaluation of eye coordination, depth perception, and convergence capabilities. |
1 | 2,800.00 | 2,800.00 |
| 3 |
Dilated Fundus Examination Internal eye health check including retina, optic nerve, and macula inspection. |
1 | 4,200.00 | 4,200.00 |
| 4 |
Prescription Lenses (High Index 1.67) Premium anti-reflective, scratch-resistant lenses tailored for high prescription strength. |
1 Pair | 12,500.00 | 12,500.00 |
| 5 |
Designer Titanium Frame Lightweight, hypoallergenic titanium frame selected during consultation. |
1 | 8,900.00 | 8,900.00 |
| 6 |
Dispensing and Adjustment Service Professional fitting, alignment, and patient education on new eyewear usage. |
1 | 1,500.00 | 1,500.00 |
Payment Instructions & Terms:
Payment is due within 14 days of the invoice date. Please include the invoice number (INV-SPB-2023-0892) in the payment reference field. For bank transfers, please use the following details:
Bank Name: Sberbank of Russia
Account Name: Neva Vision Optometry Center LLC
Account Number: 40702810500000012345
BIC: 044525225
Correspondent Account: 30101810400000000225
Late payments may incur a penalty fee of 0.1% per day on the outstanding balance.
Service Guarantee:
Neva Vision Optometry Center guarantees the quality of all optical products and professional services provided. In the event of manufacturing defects in lenses or frames, we offer a free replacement within 12 months from the date of purchase. This invoice serves as proof of purchase and warranty validity.
Optometry Consultation Notes:
The services listed above were performed by a licensed optometrist specializing in clinical optometry and low vision rehabilitation. The comprehensive examination ensures accurate prescription data, minimizing eye strain and maximizing visual comfort for daily activities. Regular check-ups are recommended every 12-18 months to monitor ocular health and update prescriptions as needed.
This invoice is issued in accordance with the Civil Code of the Russian Federation and Federal Law No. 54-FZ "On the Application of Cash Register Devices". Neva Vision Optometry Center is a registered healthcare provider in Saint Petersburg, Russia, committed to delivering high-standard optometric care. All personal data provided by the client is processed in compliance with Federal Law No. 152-FZ "On Personal Data". By accepting this invoice, the client acknowledges receipt of services and agrees to the terms of payment outlined herein. For any disputes regarding this invoice or the services rendered, please contact our billing department within 30 days. This document is valid for accounting and tax purposes within the Russian Federation.
Authorized Signature: _________________________
Dr. Elena Sokolova, Chief Optometrist
Neva Vision Optometry Center LLC
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