Pay Invoice You may pay up to 5 invoices at once using the form below. Step 1 of 2 50% Email* Enter Email Confirm Email Please provide the email address where you'd like the payment receipt sent.Phone*Client Name*Please provide the name of your organizationInvoice DetailsFor each invoice you need to pay, provide the client number, invoice number, and amount.Client Number*Invoice 1 Number*Invoice 1 Amount*Add another invoice? Add 2nd invoice? Client NumberInvoice 2 Number*Invoice 2 Amount*Add another invoice? Add 3rd invoice? Client NumberInvoice 3 Number*Invoice 3 Amount*Add another invoice? Add 4th invoice? Client NumberInvoice 4 Number*Invoice 4 Amount*Add another invoice? Add 5th invoice? Client NumberInvoice 5 Number*Invoice 5 Amount*TotalsSubtotal Price: $0.00 Processor Fee Price: $0.00 Total $0.00 NoteDo you have special instructions for this payment? Preview Data Email: {Email:5} Phone: {Phone:11} Client Name: {Client Name:1} Invoice Details Client Number Invoice Number Invoice Amount {inv1 client number:2} {Invoice 1 Number:3} {Invoice 1 Amount:16:currency} {inv2 client number:18} {Invoice 2 Number:19} {Invoice 2 Amount:13:currency} {inv3 client number:20} {Invoice 3 Number:21} {Invoice 3 Amount:14:currency} {inv4 client number:26} {Invoice 4 Number:27} {Invoice 4 Amount:28:currency} {inv5 client number:30} {Invoice 5 Number:31} {Invoice 5 Amount:32:currency} Subtotal: {Subtotal (Price):6.2} Processor Fee: {Processor Fee (Price):10.2} Total: {Total:7} Note: {Note:4} **IF** the data above looks correct, please provide your payment details below and complete your submission. If not, use the Previous button below to correct it.Payment MethodCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
