A deductible invoice separates the customer share from the insurer’s account amount. This Safelite receipt template keeps that structure, its six service rows and the complete second authorization page.
EDITOR
Edit your receipt below, then download the same clean layout as PDF or PNG. Enter amounts and totals manually.
Each service row has quantity, part code, description, list price, selling price, labor, kit, material and extended price. The tender block remains separate from the invoice’s deductible and balance labels. Page two retains the original estimate, customer authorization, revision fields, adhesive details and safe-to-drive line.
| Step | Details |
|---|---|
| 1 | Enter the invoice, claim, customer and vehicle details. |
| 2 | Reconcile the six service rows, parts and labor subtotals, tax, deductible and insurance amount manually. |
| 3 | Complete any applicable authorization fields and export both pages together. |
It includes the parts and labor charges, tax and insurer amount, while the final balance label represents the customer deductible in the selected source. The tender entries are separately editable.
The source is a deductible invoice. It shows card and account tender entries alongside a Total Balance Due label, so the editor retains those separate fields without adding a paid stamp.
The full authorization wording, original and revised estimates, customer-signature line, revision contacts, amount to collect, tender note, adhesive information and safe-to-drive line remain visible.
Safelite’s payment and billing help page directs customers to MySafelite appointment details or the confirmation email. Use your own service record to confirm the invoice and payment information.
No. All printed prices and totals are manual entries, including the six extended prices. The fictional example has USD 665.00 in parts and labor, USD 21.90 tax, a USD 200.00 deductible and USD 486.90 insurer share.