"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.

"Security Code" field is required.

Card Or Magstripe Required

Payment Amount

Select or enter your payment amount below.

Current balance $800.00

Minimum payment amount $5.00

Other amount $ Minimum payment amount is $5.00.

Billing

First Name *

Last Name *

Street Address *

City *

ZIP Code *

State *

Country *

Credit Card

Cardholder Name *

Card Number *

Expiration Date *

Security Code *

Billing

First Name *

Last Name *

Street Address *

City *

ZIP Code *

State *

Country *

Credit Card

Cardholder Name *

Card Number *

Expiration Date *

Security Code *

Invoice 15748

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From: Ohel Basya
Ohel Basya
83 Mivlal Ln
Highland MIlls, NY 10930
US

To: מייזעלס שמואל

Date: October 8, 2024

Invoice Number: 15748

Invoice Due: May 17, 2022

Invoice Total: $800.00

Balance: $800.00

Task

Rate

Qty

Amount

ראש השנה תשפ”ה שלישי

$500

1

$500
יום כיפור תשפ”ה קנה שישי

$200

1

$200
ויצא תשפ”ה חמישי

$100

1

$100

Notes

Checks paypable to: Cong Khal Milval Serpi
83 Milval Lane Highland Mills New York 10930

Terms

Please review your invoice and make payment at your earliest convenience.