Billing

First Name *

Last Name *

Street Address *

Street Address 2

City *

ZIP Code *

State *

Country *

Credit Card

Cardholder Name *

Card Number *

Expiration Date *

Expiration Date *

Security Code *

Pay Invoice

From: Mtwo Consulting Michael Mistal
1343 Evers Avenue
Westchester, IL 60154
US

To: BASE, Inc.
P.O. Box 1372
Skokie, IL 60076
US

Date: December 5, 2019

Invoice Number: 601

Invoice Due: December 19, 2019

Invoice Total: $50.00

Balance: $50.00

Service

Price

%

Amount

Professional Web Hosting:
Monthly professional web hosting services

$50

0%

$50

Notes

Thank you; we really appreciate your business.