"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
*
*
*
*
*
*
*
Credit Card
*
*
*
*
*
Billing
*
*
*
*
*
*
*
Credit Card
*
*
*
*
*
From
The Advantage Group
Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US
To
Trevor Cook
11769 ct. Rd 28.5
Akron, 80720
Date
June 5, 2018
Invoice Number
3646
Invoice Due
July 1, 2018
Invoice Total
$200.44
Balance
$200.44
  1. Task
    Rate
    Qty
    %
    Amount

    DIRECT PREMIUM BILLING

    $194.60
    1
    -3%
    $200.44
Subtotal $200.44
Total $200.44

Notes

Thank you; we really appreciate your business.