"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
Levi Frank
533 w. Lafayette
Rushville, 62681
Date
April 3, 2023
Invoice Number
341001
Invoice Due
April 30, 2023
Invoice Total
$140.41
Balance
$140.41
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing for March 2023

    $136.32
    1
    -3%
    $140.41
Subtotal $140.41
Total $140.41

Notes

Thank you; we really appreciate your business.

Status Update
April 3, 2023 @ 5:50 pm

Status changed: Draft to Pending.

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