"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
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Credit Card
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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
Bernice Stevens
31822 State Hwy 27
Guys Mills, 16327
Date
January 14, 2019
Invoice Number
4555
Invoice Due
January 31, 2019
Invoice Total
$411.16
Balance
$411.16
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing December

    $399.18
    1
    -3%
    $411.16
Subtotal $411.16
Total $411.16

Notes

Thank you; we really appreciate your business.