receipt.pdf·1 of 1
rmb_11Back to reimbursements
PSYPACT Commission
201 N Charles St Ste 1700, Baltimore MD 21201
EIN 47-3481277 · Reg #PA-290607
Receipt
TX-36B687C1
2026-04-04
Billed to
Sage Espinosa
c/o Healthy Young Minds Payroll
2400 Bryant St Ste 300, San Francisco CA 94110
Payment
VISA •••• 6094
Auth 290607
Captured 2026-04-04
SKUDescriptionQtyUnitAmount
FEEAnnual LCSW renewal1$630.11$630.11
Subtotal$630.11
Sales tax (8.875%)$55.92
Total charged$686.03
Thank you for your purchase. Items returnable within 30 days with original packaging. Questions? Email support@psypactcommission.com.
Paid · 2026-04-04
Submitted via Pelica · reimbursement rmb_11 · LicensingPage 1 of 1
Sample receipt rendered by Pelica. No real transactions occurred.