"First Name" field is required.

"Last Name" field is required.

"Street Address" field is required.

"City" field is required.

"ZIP Code" field is required.

"State" field is required.

"Country" field is required.

"Cardholder Name" field is required.

"Card Number" field is required.

"Expiration Date" field is required.

"Expiration Date" field is required.

"Security Code" field is required.

Credit card number is required.

Billing

First Name *

Last Name *

Street Address *

City *

ZIP Code *

State *

Country *

Credit Card

Cardholder Name *

Card Number *

Expiration Date *

Expiration Date *

Security Code *

Billing

First Name *

Last Name *

Street Address *

City *

ZIP Code *

State *

Country *

Credit Card

Cardholder Name *

Card Number *

Expiration Date *

Expiration Date *

Security Code *

Invoice 4561

Pay Invoice

From: The Advantage Group
Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US

To: Brandi Varnes
612 W Vine #12
LeRoy, 61752

Date: January 14, 2019

Invoice Number: 4561

Invoice Due: January 31, 2019

Invoice Total: $27.03

Balance: $27.03

Task

Rate

Qty

%

Amount

Direct Premium Billing December

$26.24

1

-3%

$27.03

Notes

Thank you; we really appreciate your business.