Billing

First Name *

Last Name *

Street Address *

City *

ZIP Code *

State *

Country *

Credit Card

Cardholder Name *

Card Number *

Expiration Date *

Expiration Date *

Security Code *

Invoice 5177

Pay Invoice

From: The Advantage Group
Advantage Group
43471 Ridge Park Drive, Suite B
Temecula, CA 92590
US

To: Johnny Martin
109 cardinal drive
Simpsonville, 40067

Date: May 13, 2019

Invoice Number: 5177

Invoice Due: May 31, 2019

Invoice Total: $476.02

Balance: $476.02

Task

Rate

Qty

%

Amount

Direct Premium Billing April

$462.16

1

-3%

$476.02

Notes

Thank you; we really appreciate your business.