"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

3375

From:Insight Family Practice

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

Phone: (801) 997-0368

insightfamilypractice@gmail.com

Invoice # 3375

Issued on March 18, 2025

Due on April 1, 2025

Balance Due $150.00

Task 1.0

Office visit on 02/03/25 as new patient

Rate

$150

Qty

Amount

$150

Total Owed

Subtotal
$150.00
Total
$150.00

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 $150.00 is Overdue Make a Payment

Make a Payment

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

Status Update 173 days ago

Status changed: Draft to Pending.

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