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 11 - TodayDecember 12 - ThursdayDecember 13 - FridayDecember 14 - SaturdayDecember 15 - SundayDecember 16 - MondayDecember 17 - TuesdayDecember 18 - WednesdayDecember 19 - ThursdayDecember 20 - Friday
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.
