"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.

Card Or Magstripe Required

Payment Amount

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Current balance $104.00
Minimum payment amount $5.00
Other amount $ Minimum payment amount is $5.00.
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From
Ohel Basya
Ohel Basya
83 Mivlal Ln
Highland MIlls, NY 10930
US
To
מאטצען בנציון
Date
August 10, 2021
Invoice Number
6560
Invoice Due
August 24, 2021
Invoice Total
$104.00
Balance
$104.00
  1. Task
    Rate
    Qty
    Amount

    פר’ עקב‎‎ שלישי

    $18
    1
    $18
  2. פר’ פנחס‎‎

    $50
    1
    $50
  3. פר’ חקת מפטיר

    $36
    1
    $36
Subtotal $104.00
Total $104.00

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.

Status Update
October 11, 2021 @ 8:32 pm

Status changed: Draft to Pending.