"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
July 17, 2020
Invoice Number
11747
Invoice Due
July 31, 2020
Invoice Total
$270.83
Balance
$270.83
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing June

    $262.94
    1
    -3%
    $270.83
Subtotal $270.83
Total $270.83

Notes

Thank you; we really appreciate your business.