Invoice Orthodontist in Indonesia Jakarta –Free Word Template Download with AI

Professional Orthodontist Services in Indonesia Jakarta

From:

Dr. Sarah Wijaya, Specialist Orthodontist
Jakarta Smile Orthodontics
Jl. Sudirman No. 123
Jakarta Selatan, Indonesia
Phone: +62 21 1234 5678
Email: [email protected]

To:

Mr. Budi Santoso
Jl. Gatot Subroto No. 45
Jakarta Pusat, Indonesia
Phone: +62 812 3456 7890
Email: [email protected]

Invoice Details:

Invoice Number: INV-2023-00123
Date: October 15, 2023
Due Date: November 15, 2023
Payment Terms: Net 30 Days

Patient Information:

Patient Name: Budi Santoso
Date of Birth: January 15, 1990
Treatment Plan: Comprehensive Orthodontic Treatment
Treatment Duration: 18 Months

Description	Quantity	Unit Price (IDR)	Total (IDR)
Initial Orthodontic Consultation	1	500,000	500,000
Comprehensive Orthodontic Examination	1	1,000,000	1,000,000
Digital X-Rays and Cephalometric Analysis	1	750,000	750,000
3D Digital Impression and Treatment Planning	1	1,500,000	1,500,000
Custom Orthodontic Braces (Metal)	1	15,000,000	15,000,000
Braces Installation and Adjustment	1	2,000,000	2,000,000
Monthly Orthodontic Adjustments (18 sessions)	18	300,000	5,400,000
Orthodontic Retainer (Post-Treatment)	1	1,000,000	1,000,000
Final Orthodontic Evaluation and Documentation	1	500,000	500,000

Subtotal: IDR 27,650,000

VAT (11%): IDR 3,041,500

Total Amount Due: IDR 30,691,500

Payment Instructions:

Please make your payment to the following bank account:
Bank: Bank Central Asia (BCA)
Account Name: Jakarta Smile Orthodontics
Account Number: 123-456-7890
SWIFT Code: CENAIDJA

For any questions regarding this invoice or your orthodontic treatment, please contact our office in Jakarta, Indonesia. We are committed to providing the highest quality orthodontic care and ensuring your satisfaction throughout your treatment journey.

Thank you for choosing Jakarta Smile Orthodontics for your orthodontic needs. We look forward to helping you achieve a beautiful, healthy smile.

Note: This invoice is valid for 30 days from the date of issue. Late payments may be subject to a 2% monthly interest charge. Please include the invoice number in your payment reference.

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