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 DateMarch 28 - TodayMarch 29 - WednesdayMarch 30 - ThursdayMarch 31 - FridayApril 1 - SaturdayApril 2 - SundayApril 3 - MondayApril 4 - TuesdayApril 5 - WednesdayApril 6 - 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.
