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 DateSeptember 25 - TodaySeptember 26 - SaturdaySeptember 27 - SundaySeptember 28 - MondaySeptember 29 - TuesdaySeptember 30 - WednesdayOctober 1 - ThursdayOctober 2 - FridayOctober 3 - SaturdayOctober 4 - Sunday
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.
