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AMERICARE MEDICAL SUPPLY

Invoice # ----------

Customer ID UANT INVOICE


REMITTANCE
BILL SHIP Invoice # -------
Date
TO TO
UANT SAME Invoice Date 11-12-09
Amount Enclosed
Customer ID UANT

DATE YOUR ORDER # OUR ORDER # SALES REP. F.O.B. SHIP VIA TERMS TAX ID

11-12 Sarah Upon rec.

QTY ITEM # MISC. DESCRIPTION DISCOUNT % TAXABLE UNIT PRICE TOTAL

1 Over the bed table 0 0 85.00 85.00


Subtotal 85.00

Tax 0
Shipping 0

Miscellaneous 0
Please make checks Payable to Americare Medical Supply.
Please return the portion below with your payment. BALANCE DUE 85.00

1724 E. Broad PHONE (817) 453-4537


AMS Ste 128
Mansfield TX 76063
FAX
E-MAIL
(817) 453-4521
americaremedical@usa.com

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