## Billing

**First Name***

**Last Name***

**Street Address***

**City***

**ZIP Code***

**State***

**Country***

## Credit Card

**Cardholder Name***

**Card Number***

**Expiration Date***  
01 - January  
02 - February  
03 - March  
04 - April  
05 - May  
06 - June  
07 - July  
08 - August  
09 - September  
10 - October  
11 - November  
12 - December

**Expiration Year***

2026  
2027  
2028  
2029  
2030  
2031  
2032  
2033  
2034  
2035

**Security Code***

This is a secure SSL encrypted payment.

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**From** BurgTech Solutions  
Joe Jordan  
6410 Cedarbrook Dr.  
Pinellas Park, FL 33782

**To** Clearvoter  
**Date** November 13, 2018  
**Invoice Number** 1929  
**Invoice Due** November 27, 2018  
**Invoice Total** $450.00  
**Balance** $450.00

| Service                           | Price | Amount |
|-----------------------------------|-------|--------|
| Reconstruct Clearvoter.com website | $300  | $300   |
| Website Hosting (10/18/18 – 10/18/19)| $150  | $150   |

## Notes
Thank you; we really appreciate your business.

## Terms
On Delivery

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