"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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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
Jeffrey Nichols
1330 Neptune
Mexico, 65265
Date
January 13, 2020
Invoice Number
6425
Invoice Due
January 31, 2020
Invoice Total
$228.58
Balance
$228.58
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing December

    $221.92
    1
    -3%
    $228.58
Subtotal $228.58
Total $228.58
Balance $228.58

Notes

Thank you; we really appreciate your business.