Paid

Invoice
From:
Professional Insurance Brokers Inc.

515 E. Carefree Hwy.
Phoenix, AZ 85085-8839

insurance@pibinc.com

Invoice Number INV-0031
Invoice Date June 29, 2017
Total Due $2,391.66
To:
Jennifer Green Psychiatric Services PLLC

4802 East Ray Road #23-591
Phoenix, AZ 85044

PROFESSIONAL LIABILITY INSURANCE - ANNUAL PREMIUM

Hrs/Qty Service Rate/PriceAdjustSub Total
1 PROFESSIONAL LIABILITY INSURANCE - ANNUAL PREMIUM

E&O PREMIUM 2,OOO
POLICY FEE 250
TAXES&FEES 72
TOTAL $2322.00

 $2,322.003%$2,391.66
Sub Total $2,391.66
Tax $0.00
Total Due $2,391.66

Payment is due upon receipt or the policy effective date which ever comes first.
By using PayPal to pay this invoice you agree to the 3% charge.

Thanks for choosing Professional Insurance Brokers | insurance@pibinc.com
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