Paid

Invoice

From:

300 Ballardvale St
Andover, MA 01810

306 Main St
Worcester, MA 01608

Invoice Number webId_ACCT# 9549
Order Number TRI COUNTY PANTHERS- ACCT# 9549
Invoice Date May 20, 2024
Total Due $0.00
To:
ESP Bill Pay General Account

INVOICE FOR TRI COUNTY PANTHERS- ACCT# 9549

Qty Service Rate/PriceSub Total
1 GL PACKAGE- HCC
$463.68$463.68
1 PARTICIPANT MEDICAL PACKAGE - AIG $575.00$575.00
Sub Total $1,038.68
Site and Service Fee (3.0%) $31.16
Paid -$1,069.84
Total Due $0.00