"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

18307 – Owed for 7/17/25 Appointment

From:Insight Family Practice

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

Phone: (801) 997-0368

insightfamilypractice@gmail.com

To:Justin Merriam

6967 S 3000 E
Salt Lake City, UT 84121
US

Phone: (801) 347-6996

Invoice # 18307

Issued on August 20, 2026

Due on September 3, 2026

Balance Due $60.27

Task 1.0

Owed for 7/17/25 Appointment (not met deductible)

Rate

$60.27

Qty

Amount

$60.27

Total Owed

Subtotal
$60.27
Total
$60.27

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 $60.27 is Overdue Make a Payment

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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

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