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