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 DateApril 14 - TodayApril 15 - ThursdayApril 16 - FridayApril 17 - SaturdayApril 18 - SundayApril 19 - MondayApril 20 - TuesdayApril 21 - WednesdayApril 22 - ThursdayApril 23 - Friday
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.
