"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.

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
Daniel VanBeek
2500 centennial rd lot 221
bismarck, 58503
Date
January 16, 2023
Invoice Number
330094
Invoice Due
January 31, 2023
Invoice Total
$379.53
Balance
$379.53
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing for December 2022

    $368.48
    1
    -3%
    $379.53
Subtotal $379.53
Total $379.53
Balance $379.53

Notes

Thank you; we really appreciate your business.

Status Update
January 16, 2023 @ 8:15 pm

Status changed: Draft to Pending.

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