CREDIT CARD PROCESSING

NOTICE:  This is NOT a secure server!  The information you enter will be converted into an E-mail and transmitted to me.  Your information is NOT stored anywhere on the Internet.  If you are concerned about transmitting this information over the Internet, complete the form, click on the link at the bottom labeled [Print Page] , and then fax the completed form to:  (818) 845-6031.

Select Card Type:
Card Number: 
Expiration Date:    Enter month/year of expiration
Security Code    What is this?
Name on the Account: 
Billing Address: 
Billing City:
Billing State: 
Billing Zip Code: 
 Daytime telephone number: 
 Client's Name (if different): 
Invoice Number you are paying:    If Retainer, write in RETAINER
Authorized amount to charge: $   
   
 

 

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