Secure Credit Card Payment

Client Name

This is the name of the client with the firm. PLEASE BE SPECIFIC. If the firm represents multiple clients, please identify the client and do each client separately, one at a time.

Cardholder Name

First

Last

Credit Card Type

CSC Code

This is a three digit code on back of card, except AMEX is a four digit on the front of the card.

Card on File

Use Card on File

Select this option only if there is a valid CC on file with the firm. The last valid card will be used.

CC Number

You may leave this field blank only if we have a valid CC Number on file.

Expiration MM/YY

You may leave this field blank only if we have a valid CC Number on file.

Special Comments

Field not required. If this credit card is, e.g., from other than the client name or at an address not associated with the person or client, this field allows you to indicate special data that may be required for the card not otherwise part of the account. Enter any special instructions.

Pay What

If you put a 0

Amount

If you put a 0 in this field, the amount of your outstanding balance or as stated in the Engagement Letter will be used for the payment. Please do separate payment entries for different client accounts, this entry is for one account only as identified above.

Email

By clicking the I Agree button, you are agreeing to the terms and conditions as stated above. You will be contacted by the firm only if your engagement is accepted. You are not a client of the firm unless you receive a written confirmation that you are a client. You should print this page for your records.

Authorize

I agree to payment

By clicking the I Agree button, you are agreeing to the terms and conditions as stated above. You will be contacted by the firm only if your engagement is accepted. You are not a client of the firm unless you receive a written confirmation that you are a client. This is an authorization form, your card will be contacted following submission. Administrative or convenience charges may be added on at the point of charge. You should print this page for your records.

Captcha

Please check this box to confirm that you are a human being and not spam or a robot.