APS - United States Credit Card Payment Form

Firm or Company Name *
Completed by *
Attorney Name (for case) *
Type NA, if this does not apply
Card Billing Street Address *
Card Billing City and State *
Card Billing Zip Code *
Phone Number *
Email Address *
Name on Credit Card *
Credit Card Type *
Credit Card Number *
Expiration Date *
Security Code (on back) *
What is this Payment for? *
Name of Company or Person being Served/Subject Name: *
Service Fee or Invoice Total *
This is the amount for the SERVICES you have selected plus any Court Filing Fees (if applicable) in this field.
Fax/Email/Upload Fee (per page) *
Add the PRINT FEE .10 cents for each page you are attaching to this order
Credit Card Processing Fee (5%) *
Add the SERVICE fee and FAX fee together for the Sub Total Amount and then add the 5% Credit Card Processing Fee to the Sub Total to get the Total Amount of this Order.
Total Fee (to be charged) *
I understand and agree that if I miscalculated the total amount for this order or if I didnít select the correct service option for my "deadline" date; Action Process Service will make the correct adjustments and charge this credit card accordingly without notice. *
I Pre-Authorize Action Process Service to charge all future Orders to this Credit Card, with no advance notice. *
Repeat Clients: In an effort to avoid entering your credit card for each order, you can complete a "one time" credit card order form and check the pre-authorization to charge all future orders to the credit card on file.
Charge all future Orders (select one) *
Signature (type name) *
Email *
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