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 DateDecember 2 - TodayDecember 3 - SaturdayDecember 4 - SundayDecember 5 - MondayDecember 6 - TuesdayDecember 7 - WednesdayDecember 8 - ThursdayDecember 9 - FridayDecember 10 - SaturdayDecember 11 - 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.
