JASK Dental Clinic

Patient ID:

ABC0001

Address Line 1
Address Line 2

Patient Name: 123456

City, State - ZipCode

Invoice Date

09/26/2012

Country

Qty

Item Number

Item Description

Price

Ext Price

1 ITEM1

Product Description - SIZE 1

1.17

1.17

2 ITEM2

Product Description - SIZE 2

9.86

19.72

3 ITEM3

Product Description - SIZE 3

9.34

28.02

4 ITEM4

Product Description - SIZE 4

7.13

28.52

5 ITEM5

Product Description - SIZE 5

2.05

10.25

6 ITEM6

Product Description - SIZE 6

0.89

5.34

7 ITEM7

Product Description - SIZE 7

3.54

24.78

8 ITEM8

Product Description - SIZE 8

1.55

12.40

9 ITEM9

Product Description - SIZE 9

3.26

29.34

10 ITEM10

Product Description - SIZE 10

3.63

36.30

11 ITEM11

Product Description - SIZE 11

9.12

100.32

12 ITEM12

Product Description - SIZE 12

8.61

103.32

13 ITEM13

Product Description - SIZE 13

8.50

110.50

14 ITEM14

Product Description - SIZE 14

7.84

109.76

15 ITEM15

Product Description - SIZE 15

0.79

11.85

16 ITEM16

Product Description - SIZE 16

7.57

121.12

17 ITEM17

Product Description - SIZE 17

3.83

65.11

18 ITEM18

Product Description - SIZE 18

2.56

46.08

19 ITEM19

Product Description - SIZE 19

3.18

60.42

20 ITEM20

Product Description - SIZE 20

3.11

62.20

21 ITEM21

Product Description - SIZE 21

9.30

195.30

22 ITEM22

Product Description - SIZE 22

5.71

125.62

23 ITEM23

Product Description - SIZE 23

6.64

152.72

24 ITEM24

Product Description - SIZE 24

3.08

73.92

25 ITEM25

Product Description - SIZE 25

2.28

57.00

26 ITEM26

Product Description - SIZE 26

3.37

87.62

27 ITEM27

Product Description - SIZE 27

0.91

24.57

28 ITEM28

Product Description - SIZE 28

1.90

53.20

29 ITEM29

Product Description - SIZE 29

0.35

10.15

30 ITEM30

Product Description - SIZE 30

5.42

162.60

31 ITEM31

Product Description - SIZE 31

5.08

157.48

32 ITEM32

Product Description - SIZE 32

7.65

244.80

33 ITEM33

Product Description - SIZE 33

9.32

307.56

34 ITEM34

Product Description - SIZE 34

4.10

139.40

35 ITEM35

Product Description - SIZE 35

8.87

310.45

36 ITEM36

Product Description - SIZE 36

1.67

60.12

37 ITEM37

Product Description - SIZE 37

0.02

0.74

38 ITEM38

Product Description - SIZE 38

6.53

248.14

Page No. 1

JASK Dental Clinic

Patient ID:

ABC0001

Address Line 1
Address Line 2

Patient Name: 123456

City, State - ZipCode

Invoice Date

09/26/2012

Country

Qty

Item Number

Item Description

Price

Ext Price

39 ITEM39

Product Description - SIZE 39

3.21

125.19

40 ITEM40

Product Description - SIZE 40

9.83

393.20

41 ITEM41

Product Description - SIZE 41

7.73

316.93

42 ITEM42

Product Description - SIZE 42

0.38

15.96

43 ITEM43

Product Description - SIZE 43

7.84

337.12

44 ITEM44

Product Description - SIZE 44

3.35

147.40

45 ITEM45

Product Description - SIZE 45

0.12

5.40

46 ITEM46

Product Description - SIZE 46

4.52

207.92

47 ITEM47

Product Description - SIZE 47

9.91

465.77

48 ITEM48

Product Description - SIZE 48

5.64

270.72

49 ITEM49

Product Description - SIZE 49

2.25

110.25

50 ITEM50

Product Description - SIZE 50

2.56

128.00

51 ITEM51

Product Description - SIZE 51

0.15

7.65

52 ITEM52

Product Description - SIZE 52

8.53

443.56

53 ITEM53

Product Description - SIZE 53

2.58

136.74

54 ITEM54

Product Description - SIZE 54

8.18

441.72

55 ITEM55

Product Description - SIZE 55

2.89

158.95

56 ITEM56

Product Description - SIZE 56

7.80

436.80

57 ITEM57

Product Description - SIZE 57

9.97

568.29

58 ITEM58

Product Description - SIZE 58

5.29

306.82

59 ITEM59

Product Description - SIZE 59

1.66

97.94

60 ITEM60

Product Description - SIZE 60

3.16

189.60

61 ITEM61

Product Description - SIZE 61

9.56

583.16

62 ITEM62

Product Description - SIZE 62

5.00

310.00

63 ITEM63

Product Description - SIZE 63

4.95

311.85

64 ITEM64

Product Description - SIZE 64

2.16

138.24

65 ITEM65

Product Description - SIZE 65

5.28

343.20

66 ITEM66

Product Description - SIZE 66

3.95

260.70

67 ITEM67

Product Description - SIZE 67

5.58

373.86

68 ITEM68

Product Description - SIZE 68

1.27

86.36

69 ITEM69

Product Description - SIZE 69

7.28

502.32

70 ITEM70

Product Description - SIZE 70

5.30

371.00

71 ITEM71

Product Description - SIZE 71

2.71

192.41

72 ITEM72

Product Description - SIZE 72

9.72

699.84

73 ITEM73

Product Description - SIZE 73

5.71

416.83

74 ITEM74

Product Description - SIZE 74

4.67

345.58

75 ITEM75

Product Description - SIZE 75

7.70

577.50

76 ITEM76

Product Description - SIZE 76

3.21

243.96

Page No. 2

JASK Dental Clinic

Patient ID:

ABC0001

Address Line 1
Address Line 2

Patient Name: 123456

City, State - ZipCode

Invoice Date

09/26/2012

Country

Qty

Item Number

Item Description

Price

Ext Price

77 ITEM77

Product Description - SIZE 77

6.12

471.24

78 ITEM78

Product Description - SIZE 78

7.93

618.54

79 ITEM79

Product Description - SIZE 79

3.80

300.20

80 ITEM80

Product Description - SIZE 80

5.60

448.00

81 ITEM81

Product Description - SIZE 81

7.62

617.22

82 ITEM82

Product Description - SIZE 82

7.09

581.38

83 ITEM83

Product Description - SIZE 83

4.96

411.68

84 ITEM84

Product Description - SIZE 84

6.07

509.88

85 ITEM85

Product Description - SIZE 85

2.32

197.20

86 ITEM86

Product Description - SIZE 86

3.07

264.02

87 ITEM87

Product Description - SIZE 87

0.61

53.07

88 ITEM88

Product Description - SIZE 88

8.34

733.92

89 ITEM89

Product Description - SIZE 89

3.30

293.70

90 ITEM90

Product Description - SIZE 90

1.74

156.60

91 ITEM91

Product Description - SIZE 91

2.18

198.38

92 ITEM92

Product Description - SIZE 92

6.07

558.44

93 ITEM93

Product Description - SIZE 93

8.92

829.56

94 ITEM94

Product Description - SIZE 94

0.25

23.50

95 ITEM95

Product Description - SIZE 95

1.58

150.10

96 ITEM96

Product Description - SIZE 96

5.91

567.36

97 ITEM97

Product Description - SIZE 97

3.27

317.19

98 ITEM98

Product Description - SIZE 98

6.28

615.44

99 ITEM99

Product Description - SIZE 99

3.75

371.25

100 ITEM100

Product Description - SIZE 100

5.22

522.00

Page No. 3