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Payments
**the office will send you an email reply upon the attempt to process with details on outcome**
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* Indicates required question
Email (Rep Account)*
*
Your answer
Customer Name (or Number)
*
Your answer
Invoice #
*
Your answer
How will payment be processed?
*
Re-Process the Card Previously Used (provide last 4 CC digits below)
Process the New Card on the Customer's Account (provide last 4 CC digits below)
Process via e-Check (ACH from Bank Account) (provide last 4 digits of ACH Account below)
I will collect the money from the customer. Change payment to Net10* (*only eligible accounts)
What is the amount due on the invoice?
*
Your answer
Verify the last 4 digits of the card/e-Check account
to be charged .
*
Keep Net 10 payment only: enter 0 below*
Last four are required for credit cards/ACH payments.
*
Your answer
Note or Message for the Office
Your answer
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