Paid

Invoice

From:

300 Ballardvale St
Andover, MA 01810

306 Main St
Worcester, MA 01608

Invoice Number webId_ACCT#14450
Order Number PONTIAC JFL- ACCT#14450
Invoice Date May 28, 2024
Total Due $0.00
To:
ESP Bill Pay General Account

INVOICE FOR PONTIAC JFL- ACCT#14450

Qty Service Rate/PriceSub Total
1 GL PACKAGE- HCC
$744.72$744.72
1 PARTICIPANT MEDICAL PACKAGE - AIG $1,400.00$1,400.00
Sub Total $2,144.72
Site and Service Fee (3.0%) $64.34
Paid -$2,209.06
Total Due $0.00