Five Stones Marketing Payment Form
Company Name
*
Invoice Number
*
Please enter your Five Stones Marketing Invoice Number
Payment amount: $
*
A 3.5% Transaction Fee is automatically applied to ALL online payments)
3.5% Convenience Fee
*
Total amount being charged to your card:
*
TOTAL AMOUNT BEING CHARGED TO YOUR CARD (including the 3.5% transaction fee):
*
USD
TOTAL AMOUNT BEING CHARGED TO YOUR CARD INCLUDING THE AUTOMATIC 3.5% TRANSACTION FEE
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Enter Signature Using Pen Tablet or Mouse
*
Clear
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
All Sales are U.S. Dollars. All Sales are Final.
Submit
Should be Empty: