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 11747

Pay Invoice

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: July 17, 2020

Invoice Number: 11747

Invoice Due: July 31, 2020

Invoice Total: $270.83

Balance: $270.83

Task

Rate

Qty

%

Amount

Direct Premium Billing June

$262.94

1

-3%

$270.83

Notes

Thank you; we really appreciate your business.