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 DateJuly 13 - TodayJuly 14 - MondayJuly 15 - TuesdayJuly 16 - WednesdayJuly 17 - ThursdayJuly 18 - FridayJuly 19 - SaturdayJuly 20 - SundayJuly 21 - MondayJuly 22 - 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.
