"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.

E00003 The element 'creditCard' in namespace 'AnetApi/xml/v1/schema/AnetApiSchema.xsd' has invalid child element 'expirationDate' in namespace 'AnetApi/xml/v1/schema/AnetApiSchema.xsd'. List of possible elements expected: 'cardNumber' in namespace 'AnetApi/xml/v1/schema/AnetApiSchema.xsd'.

Payment Pending

20661 – Owed for Blood Draw on 6/26/26

From:Insight Family Practice

8686 S 1300 E, Suite L102-104
Sandy, UT 84094
US

Phone: (801) 997-0368

insightfamilypractice@gmail.com

To:Jaycie Haroldsen

255 E Fort Union blvd
unit 11
Midvale, UT 84047
US

Phone: (801) 819-6955

Invoice # 20661

Issued on September 30, 2026

Due on October 14, 2026

Balance Due $129.22

Task 1.0

Owed for Blood Draw on 6/26/26 (Selfpay)

Rate

$129.22

Qty

Amount

$129.22

Total Owed

Subtotal
$129.22
Total
$129.22

Info & Notes

Thank you; we really appreciate your business.

Terms & Conditions

We do expect payment within 21 days, so please process this invoice within that time. There will be a 1.5% interest charge per month on late invoices.

Balance of $129.22 is Overdue Make a Payment

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Country *

Cardholder Name *

Card Number *

Expiration Date *

Security Code *

First Name *

Last Name *

Street Address *

Street Address 2

City *

ZIP Code *

State *

Country *

Cardholder Name *

Card Number *

Expiration Date *

Security Code *

Invoice History

Updated 22 days ago

Invoice updated by info@utahwebdesignpros.com.

Viewed 18 days ago

Invoice viewed by 83.99.206.18 for the first time.

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