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 5167

Pay Invoice

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

To: Chad Kibler
445 Halls Corners rd
Attica, 14011

Date: May 13, 2019

Invoice Number: 5167

Invoice Due: May 31, 2019

Invoice Total: $29.22

Balance: $29.22

Task

Rate

Qty

%

Amount

Direct Premium Billing April

$28.37

1

-3%

$29.22

Notes

Thank you; we really appreciate your business.