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 16 - TodayMarch 17 - MondayMarch 18 - TuesdayMarch 19 - WednesdayMarch 20 - ThursdayMarch 21 - FridayMarch 22 - SaturdayMarch 23 - SundayMarch 24 - MondayMarch 25 - 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.
