"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
Kevin Mason
8246 liv 239
chillicothe, MO 64601
US
Date
December 23, 2020
Invoice Number
17201
Invoice Due
December 31, 2020
Invoice Total
$557.85
Balance
$557.85
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing November

    $541.60
    1
    -3%
    $557.85
Subtotal $557.85
Total $557.85

Notes

Thank you; we really appreciate your business.

Status Update
December 23, 2020 @ 6:14 pm

Status changed: Draft to Pending.