"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
Zackery Faubert
1509 Washington St
Huntingdon, 16652
Date
August 19, 2020
Invoice Number
12958
Invoice Due
August 31, 2020
Invoice Total
$187.82
Balance
$187.82
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing July

    $182.35
    1
    -3%
    $187.82
Subtotal $187.82
Total $187.82

Notes

Thank you; we really appreciate your business.

Status Update
August 19, 2020 @ 5:06 pm

Status changed: Draft to Pending.