I hereby certify, as payor of this bill, I have funds available in my account on the specified transaction date. I also understand if my payment is returned for any reason, I will be liable for the $35.00 fee that will be charged.


    First name:*

    Last name:*

    Phone:*

    Address:*

    City:*

    (30 character limit)

    State:*

    Zip:*

    Email Address:*

    Invoice Number:*

    See upper left hand corner of your invoice

    Address Where Work Will Be/Was Performed:*
    Please provide street address and city

    (60 character limit)

    Amount to Pay:*
    $
    (0000.00 no commas and max is 5000)

    Routing:*

    Account:*

    Re-type Account:*

    Bank Name:*

    Bank Account Type:*

    I agree to terms of service.

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