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 DateJune 24 - TodayJune 25 - SaturdayJune 26 - SundayJune 27 - MondayJune 28 - TuesdayJune 29 - WednesdayJune 30 - ThursdayJuly 1 - FridayJuly 2 - SaturdayJuly 3 - 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.
