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 DateAugust 9 - TodayAugust 10 - MondayAugust 11 - TuesdayAugust 12 - WednesdayAugust 13 - ThursdayAugust 14 - FridayAugust 15 - SaturdayAugust 16 - SundayAugust 17 - MondayAugust 18 - 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.
