"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
francis yeckley
951 brysonia wenksville rd
biglerville, 17307
Date
February 10, 2022
Invoice Number
298703
Invoice Due
February 28, 2022
Invoice Total
$142.42
Balance
$142.42
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing January

    $138.27
    1
    -3%
    $142.42
Subtotal $142.42
Total $142.42
Balance $142.42

Notes

Thank you; we really appreciate your business.

Status Update
February 10, 2022 @ 7:23 pm

Status changed: Draft to Pending.

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