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 6167

Pay Invoice

From: The Advantage Group
Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US

To: Jimmie Saldana
223 W 5th St
Grafton, 58237

Date: November 13, 2019

Invoice Number: 6167

Invoice Due: November 30, 2019

Invoice Total: $150.90

Balance: $150.90

Task

Rate

Qty

%

Amount

Direct Premium Billing October

$146.50

1

-3%

$150.90

Notes

Thank you; we really appreciate your business.