Client Payment Information

Responsible Party (As it appears on Card):

First Name:

Last Name:

Billing Address:

City:

State:

Zip:

Email:

Property Address :

Payment Due Date:

X
Sun Mon Tue Wed Thu Fri Sat

Payment Type:

Payment Purpose:

Payment Amount $

TOTAL PAYMENT :

A surcharge to process this payment has been outlined above. The fee is separate from the primary obligation you are paying. The surcharge fee will be included in the “Total Payment”. In the event your payment is not processed or authorized by your card company or the applicable entity you are seeking to pay fails to accept your payment or, your payment liability shall remain outstanding and unpaid and you will be subject to all applicable penalties, late fees and interest charges assessed by the relevant entity thereon, all of which obligations remain your sole responsibility.

Card Authorization Agreement

By clicking the "Accept" button below you hereby confirm your acceptance of the surcharge and agree to pay the "Total Payment" amount indicated, subject to and in accordance with the agreement governing the use of your credit or debit card.

I Accept