Third Party Verification Payment form
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
Company Name
PAYMENT
Verification Fee + 2.9% Credit Card Charge Fee + $0.31 Stripe Fee +$1.00 Third Party Process Fee
Third Party Verification Payment Fee
prev
next
( X )
Payment A
$
51.68
Total before Third Party Processing fee=$48.95
Payment B
$
28.00
Total before Processing fee=$26
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: