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10
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1
Name
*
This field is required.
First Name
Last Name
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2
Email
*
This field is required.
example@example.com
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3
Phone Number
*
This field is required.
Please enter a valid phone number.
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4
Date
*
This field is required.
-
Payment Date
Month
Day
Year
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5
Store Location
Commerce Cleaners
B & S Laundry
Superior Cleaners
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6
Invoice #, Statement #, or Customer #
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7
Statement or Invoice Total Due
Payment Amount
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8
Transaction Fee
*
This field is required.
3% Transaction Fee
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9
PDF or Picture upload of statement or invoice being paid. (Optional)
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Please upload a PDF or pic of the invoice or statement you are paying.
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10
Please verify that you are human
*
This field is required.
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11
Dry Cleaning & Laundry Total
A 3% transaction is added to online payments.
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( X )
3% fee added to online payments
USD
+ OR enter a custom value
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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Should be Empty:
Commerce Cleaners Online Payment
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