Invoice Number: | 142658 |
Billing Period: | 01/01/2007 - 01/31/2007 |
Vision Group Number: | 40001-000-00000-00000 |
Group Name: | VISION |
Master Number: | 40001 |
Description: | |
Phone Number: | (999) 999-0000 |
VISION |
GILLIAN MYERS |
VP SECRETARY |
2245 BLUE JAY WAY |
ANYWHERE, USA 55555-0000 |
CURRENT PREMIUM BILLED |
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Number of Subscribers | Coverage Choice | Rate | Amount Due |
---|
2 | Single | units at | $ | 9.72 | | per unit equals | $ | 19.44 | |
2 | S+Children | units at | $ | 21.38 | | per unit equals | $ | 42.76 | |
|
| Current Billed: | $ | 62.20 | |
ACTIVE SUBSCRIBERS |
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Member Number | Member Last Name | Member First Name | Coverage Type | Effective Date | Amount Due |
---|
00231524089 | ADAMS | SARAH | Single | 01/01/2007 | $ | 9.72 | |
00888888888 | ALBERTSON | BRENDA | S+Family | 07/01/1985 | $ | 21.38 | |
00999999999 | ALLEN | SALLY | Single | 09/01/2001 | $ | 9.72 | |
00101010101 | ALOMAR | MARIA | S+Family | 04/01/2006 | $ | 21.38 | |
|
| | | | Current Billed: | $ | 62.20 | |