"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.

Billing
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Credit Card
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From
The Advantage Group Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US
To
David St Martin
114 CHESTNUT STREET
REHOBOTH, 02769
Date
August 6, 2024
Invoice Number
541452
Invoice Due
August 31, 2024
Invoice Total
$503.07
Balance
$503.07
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing for July 2024

    $488.42
    1
    -3%
    $503.07
Subtotal $503.07
Total $503.07

Notes

Thank you; we really appreciate your business.

Status Update
August 6, 2024 @ 8:21 pm

Status changed: Draft to Pending.

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