"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
Gavin Dunmier
1110 Angell Ave
Three Rivers, 49093
Date
November 9, 2021
Invoice Number
255352
Invoice Due
November 30, 2021
Invoice Total
$4.28
Balance
$4.28
  1. Task
    Rate
    Qty
    %
    Amount

    Direct Premium Billing October

    $4.16
    1
    -3%
    $4.28
Subtotal $4.28
Total $4.28

Notes

Thank you; we really appreciate your business.

Status Update
November 9, 2021 @ 12:56 am

Status changed: Draft to Pending.