"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
*
*
*
*
*
*
*
Credit Card
*
*
*
*
*
From
The Advantage Group Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US
To
Shayne Miller
Po Box 242
Grand Rapids, 55744
Date
May 7, 2024
Invoice Number
540156
Invoice Due
May 31, 2024
Invoice Total
$696.36
Balance
$696.36
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing for April 2024

    $676.08
    1
    -3%
    $696.36
Subtotal $696.36
Total $696.36

Notes

Thank you; we really appreciate your business.

Status Update
May 7, 2024 @ 6:06 pm

Status changed: Draft to Pending.