Payment Receipt Form

Balance Summary

Total Amount (Inc. Extra Costs): 0.00 EUR

Total Received Amount: 0.00 EUR

Balance: 0.00 EUR

Booking Notes

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Patient (Hasta)

Payment Type (Ödeme Tipi)

Payment Method (Ödeme Yöntemi)

Payment Date (Ödeme Tarihi)

Amount to be Collected from Patient (Hastadan Tahsil Edilecek Tutar)

* Adds 20% (VAT) + 2.05% (Bank Comm.) to Sent Amount.

Sent Amount to Account (Hesaba Gönderilen Tutar)

Received Amount to Account (Hesaba Ulaşan Tutar)

Net amount after financial institutes (Banks, WU, Moneygram, Wise etc.) deductions

Quote Currency Equivalent (Teklif Para Birimi Karşılığı)

Since the currency does not match the Deal Currency, please enter the equivalent amount of this payment in Deal Currency (the quote currency). The balance will be calculated based on this amount.

Sales Person (Satışı Yapan Kişi)

Payment Holder Position (Ödemeyi Alan Kişinin Pozisyonu)

Payment Holder Name (Ödemeyi Alan Kişi)

Payment Notes (Ödeme Notları)

Payment Document/s (Ödeme Belgesi/Belgeleri)

Product Management (Ürün Yönetimi)

Name (İsim) Qty (Adet) Unit Price (Birim Fiyat) Total (Toplam) Discount (İndirim) Curr. (Para Birimi) Actions (İşlemler)

No products in this deal.

Select Catalog (Katalog Seç)

Add Product from Catalog (Katalogdan Ürün Ekle)

Third Party Payments

Add extra costs like Insurance, Medical Tests, etc. These increase the Total Amount.

Type

Package / Policy

Amount

Curr.

Type Package Amount / Currency Action

No third party payments.

Payment Receipt Form

Balance Summary

Product Management (Ürün Yönetimi)

Third Party Payments

🏢 Merkezi Nakit Yönetimi