"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

16379 – Owed for 2/5/25 and 5/5/25 Appointments

From:Insight Family Practice

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

Phone: (801) 997-0368

insightfamilypractice@gmail.com

To:Courtney Hatjes

33 East 400 North
Saint George, UT 84770
US

Phone: (801) 205-0650

Invoice # 16379

Issued on August 4, 2026

Due on August 18, 2026

Balance Due $200.00

Task 1.0

Owed for 2/5/25 Appointment (not met deductible)

Rate

$100

Qty

Amount

$100

Task 2.0

Owed for 5/5/25 Appointment (not met deductible)

Rate

$100

Qty

Amount

$100

Total Owed

Subtotal
$200.00
Total
$200.00

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 $200.00 is Overdue Make a Payment

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Please enter your payment information to pay this invoice. A receipt for your records will be sent to you. Thank you very much!

Credit Card

First Name *

Last Name *

Street Address *

Street Address 2

City *

ZIP Code *

State *

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 19 days ago

Invoice updated by info@utahwebdesignpros.com.

Viewed 19 days ago

Invoice viewed by 96.60.179.77 for the first time.

Viewed 16 days ago

Invoice viewed by 90.108.167.143 for the first time.

Viewed 15 days ago

Invoice viewed by 50.71.184.44 for the first time.

Viewed 13 days ago

Invoice viewed by 95.252.66.229 for the first time.

Viewed 12 days ago

Invoice viewed by 83.193.43.114 for the first time.

Viewed 10 days ago

Invoice viewed by 83.99.206.234 for the first time.

From:Insight Family Practice

To:Courtney Hatjes

Task 1.0

Rate

Qty

Amount

Task 2.0

Rate

Qty

Amount

Total Owed

Subtotal

Total

Info & Notes

Terms & Conditions

Make a Payment

Invoice History