"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
Joshua Williams
5473 PALDI RD
PECK, 48466
Date
January 5, 2024
Invoice Number
490712
Invoice Due
January 31, 2024
Invoice Total
$152.91
Balance
$152.91
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing for December 2023

    $148.46
    1
    -3%
    $152.91
Subtotal $152.91
Total $152.91

Notes

Thank you; we really appreciate your business.

Status Update
January 5, 2024 @ 11:20 pm

Status changed: Draft to Pending.