"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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From
The Advantage Group
Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US
To
Dan Paschke
20151 Saddle Ct.
Whitewood, 57793
Date
July 9, 2018
Invoice Number
3937
Invoice Due
July 31, 2018
Invoice Total
$540.29
Balance
$540.29
  1. Tasks
    Rate
    Qty
    %
    Amount

    DIRECT PREMIUM BILLING

    $524.55
    1
    -3%
    $540.29
Subtotal $540.29
Total $540.29

Notes

Thank you; we really appreciate your business.