Make a Payment with a Verified Bank Account

Make a Payment with a Verified Bank Account

To make a one-time payment against an account statement or other balance, please use the form below. Thanks!
Name or Company Name*
Please enter a name or company name that appears on a reference to your payment such as your account statement or invoice.
Email*
example@example.com
Additional Information*
Please provide any additional payment information or references such as invoice numbers or statement date.
Payment Amount*
USD
Bank Account Number (last 4 digits)*
Please note: If your bank account has not already been verified, we will send a notification to do so after your submission is received. You may also manually add your bank details for verification.
Should be Empty: