"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
Luke Elliott
521 10th ave W
Alexandria, 56308
Date
June 25, 2019
Invoice Number
5533
Invoice Due
June 30, 2019
Invoice Total
$219.20
Balance
$219.20
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing May

    $212.82
    1
    -3%
    $219.20
Subtotal $219.20
Total $219.20

Notes

Thank you; we really appreciate your business.