"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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From
The Advantage Group
Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US
To
Michael Whidden
8632 ALIZARIN AVENUE
Cicero, 13039
Date
May 14, 2020
Invoice Number
8334
Invoice Due
May 31, 2020
Invoice Total
$107.22
Balance
$107.22
  1. Tasks
    Rate
    Qty
    %
    Amount

    Direct Premium Billing April

    $104.10
    1
    -3%
    $107.22
Subtotal $107.22
Total $107.22

Notes

Thank you; we really appreciate your business.