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 9987

Pay Invoice

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

To: Levi Burkholder
11132 coster sw
Fife lake, 49633

Date: June 15, 2020

Invoice Number: 9987

Invoice Due: June 30, 2020

Invoice Total: $181.65

Balance: $181.65

Task

Rate

Qty

%

Amount

Direct Premium Billing May

$176.36

1

-3%

$181.65

Notes

Thank you; we really appreciate your business.