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 24 - TodaySeptember 25 - MondaySeptember 26 - TuesdaySeptember 27 - WednesdaySeptember 28 - ThursdaySeptember 29 - FridaySeptember 30 - SaturdayOctober 1 - SundayOctober 2 - MondayOctober 3 - Tuesday
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.
