"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
Adrian Duel
850 Capital Walk Drive Apt#2209
Tallahassee, 32303
Date
October 16, 2020
Invoice Number
13498
Invoice Due
October 31, 2020
Invoice Total
$72.69
Balance
$72.69
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing September

    $70.57
    1
    -3%
    $72.69
Subtotal $72.69
Total $72.69

Notes

Thank you; we really appreciate your business.

Status Update
October 16, 2020 @ 3:55 pm

Status changed: Draft to Pending.