"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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From
The Advantage Group
Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US
To
Eric Porth
51898 County Road 310
Bigfork, 56628
Date
June 10, 2019
Invoice Number
5417
Invoice Due
June 30, 2019
Invoice Total
$26.71
Balance
$26.71
  1. Tasks
    Rate
    Qty
    %
    Amount

    Direct Premium Billing May

    $25.93
    1
    -3%
    $26.71
Subtotal $26.71
Total $26.71

Notes

Thank you; we really appreciate your business.