SMH Stripe- Payment

Sentinel Mental Health - Payment
Card Holder Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Is the Card Holder the Client?*

YesNo
Name of Client

First NameLast Name
Is payment for any other clients?*

YesNo
How many additional Clients?
Name of Client

First NameLast Name
Name of Client

First NameLast Name
Name of Client

First NameLast Name
Please make a payment type selection.*

Credit Card - 3.5% processing fee added.ACH - connect to your bank account with approximately .50c / transaction
After Clicking "Submit" you will be directed to the Credit Card / ACH page in Stripe. (ACH connects to your bank account and avoids typical Credit Card fees)
Payment amount
Should be Empty:

Sentinel Mental Health - Payment