"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 257579

Pay Invoice

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

To: Claudio Mendoza
PO Box 1452 405 Howard st
Moody, TX 76557
US

Date: December 13, 2021

Invoice Number: 257579

Invoice Due: December 31, 2021

Invoice Total: $266.64

Balance: $266.64

Task

Rate

Qty

%

Amount

Direct Premium Billing November

$258.87

1

-3%

$266.64

Notes

Thank you; we really appreciate your business.

Status Update
December 13, 2021 @ 6:53 pm

Status changed: Draft to Pending.