Client Name: If not the person identified below.
As identified on the invoice related to this payment.
Note for clients with multiple accounts or separate invoices:
Please do not aggregate client accounts into one payment. Please do a separate
payment for each client. Please specify the client name used on the invoice
sent to you to avoid misapplications of your payment.
(Amex 4 Digits Front; MC/V 3 Digits on Back)
Number: Use credit card on file (preferred)
(We will contact you if necessary)
Email (for confirmation):
Confirmations are when processed by us, probably, but not necessary, immediately.
You should receive an immediate confirmation page on your screen.
If you do not receive an email confirmation from us with a few days, please
let us know.
You are required to electronically sign this form
by typing in your name preceded by /s/
e.g. /s/ John Doe
By clicking the I Agree button, you are agreeing to
pay the amount above by the credit card identified.
You should print this page for your records.
You will receive a Confirmation page if the form completes.