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Square Payments
1
Client Name
*
This field is required.
First Name
Last Name
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2
Description (invoice #, date(s) of service, etc)
*
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3
Provider Info
Please list Therapist Name
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4
Pay your bill online
*
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( X )
Description
USD
+ OR enter a custom value
Credit Card
First Name
Last Name
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5
Email
*
This field is required.
type e-mail address for receipt
example@example.com
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6
Phone Number
*
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Area Code
Phone Number
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