credit card form1-7-23

SBWDesigns Credit/debit Card Payment

Website Name (if applicable)

Invoice Number (if known or applicable)

Amount of Payment

ALL FIELDS ARE REQUIRED UNLESS OTHERWISE STATED

Name as it appears on credit card

Billing Address

Apt./Unit # (if applicable)

City, State, Zip Code

MUST INCLUDE BILLING ZIP CODE

Contact Phone Number

Email (optional if you would like to recieve confirmation of your payment)

Credit Card Number (DO NOT USE SPACE OR DASHSES )

DO NOT USE SPACE OR DASHSES (-)

Expiration Month

Expiration Year

3 or 4 digit security code on back (front for Amex)

DO NOT USE SPACE OR DASHSES (-)

AFTER SUBMITTING, PLEASE WAIT WHILE WE PROCESS YOUR PAYMENT. YOU WILL BE RE-DIRECTED
(20-30 seconds) DO NOT HIT SUBMIT MORE THAN ONCE PLEASE

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