"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

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Current balance $200.00

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 16242

Make Payment Pay Invoice

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

To: יאקאבאוויטש אהרן

Date: November 12, 2024

Invoice Number: 16242

Invoice Due: May 11, 2020

Invoice Total: $200.00

Balance: $200.00

Task

Rate

Qty

Amount

לך לך תשפ”ה שלישי

$100

1

$100
וישב תשפ”ה שלישי

$100

1

$100

Notes

Milval – Surpei Shul 83 Milval Lane Highland Mills New York 10930

Terms

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