"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.

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Credit Card
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Billing
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Credit Card
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From
Ohel Basya Ohel Basya
83 Mivlal Ln
Highland MIlls, NY 10930
US
To
בערקאוויטש יצחק
Date
October 12, 2021
Invoice Number
6906
Invoice Due
October 26, 2021
Invoice Total
$18.00
Balance
$18.00
  1. Task
    Rate
    Qty
    Amount

    שבת חוה״מ סוכות רביעי

    $18
    1
    $18
Subtotal $18.00
Total $18.00

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.

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