Paid

Invoice

From:

300 Ballardvale St
Andover, MA 01810

306 Main St
Worcester, MA 01608

Invoice Number webId_ACCT#28699
Order Number LUTHERVILLE KNIGHTS - ACCT#28699
Invoice Date May 14, 2024
Total Due $0.00
To:
ESP Bill Pay General Account

INVOICES FOR LUTHERVILLE KNIGHTS - ACCT#28699

Qty Service Rate/PriceSub Total
1 GL PACKAGE - HCC
$312.00$312.00
1 PARTICIPANTS MEDICAL PACKAGE - AIG $400.00$400.00
Sub Total $712.00
Site and Service Fee (3.0%) $21.36
Paid -$733.36
Total Due $0.00