Attending to your account payments:

Account Payment Form

Retainer/Account Payment Form

1. Name as shown on credit card:

2. Date this form is being submitted This question requires a valid date format of MM/DD/YYYY.

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3. Credit Card Type

4. Date of Expiry shown on the Credit Card This question requires a valid date format of MM/DD/YYYY.

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5. Amount of Payment Authorized This question requires a valid number format.

6. Name of person authorizing this transaction (note - must be same as card holder)

7. Credit Card Number

8. Payment frequency: The above noted payment is authorized: