PLEASE SELECT YOUR FORM OF PAYMENT

Credit/Debit Card Authorization Form

File Number

Example 2024-0001

Payment Amount

Payment Date

The date that you want the payment to be processed

YYYY

Payer Name

Card Number

no space or dashes

CVV

CVV stands for Card Verification Value. It is a 3 or 4 digit number located on the back of your card, and on the front for AMEX.

Expiration Month

Expiration Year

Zip Code

Five digit Zip Code

Email Address

We need your email to send you confirmation of payment

Phone Number

Example 5555555555

ACH Authorization Form

File Number

Example 2024-0001

Payment Amount

Payment Date

The date that you want the payment to be processed

YYYY

Name on Account

Bank Name

Checking or Savings

ABA/Routing Number

Bank Account Number

Confirm Bank Account Number

Please confirm bank account number

Email Address

We need your email to send you confirmation of payment

Phone Number

Example 5555555555

There is a $5.00 convenience fee for any credit/debit card payments.

There is a $25.00 fee assessed for any returned ACH payments.

There is no processing fee for ACH payments.

Payment Form