Client ID (from invoice) *
Business Name *
First Name
Last Name
Address Line 1
Address Line 2
City
State
ZIP Code
Phone Number
Email Address (for confirmation)
Invoice #
Amount (USD) *
Payment DateJune 24 - TodayJune 25 - FridayJune 26 - SaturdayJune 27 - SundayJune 28 - MondayJune 29 - TuesdayJune 30 - WednesdayJuly 1 - ThursdayJuly 2 - FridayJuly 3 - Saturday
Payment FrequencyOne TimeOnce Every WeekOnce Every MonthOnce Every 3 Months (Quarterly)Once Every Year
Memo
* I understand that a 2.75% processing fee will be added to my total.
