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Drag and drop csv file with emails

Online Payment Portal

First Name *

Last Name *

Address *

Phone Number *

Phone form field Phone Number must be in the format: (000) 000-0000

Email *

Email form field Email is not in correct form

Is the invoice under someone else's name? Value is not selected

First Name on the Invoice

Last Name on the Invoice

Invoice/Receipt Number

Person ID

Payment Amount *

Currency Form field Payment Amount requires format 1,000.00

Date

Date form field Date must be in the format: MM/dd/yyyy

Sample

Fee type (check all that apply) *

Fee type (check all that apply)

Quarantine

Return to Owner

Commercial Kennel Permit

Pet Fancier Permit

Adoption

Owner Surrender

Dangerous Dog Registration

Outside Vet Fees

Veterinary Care Services

I want to add a donation to my payment * Value is not selected

Donation Amount *

Currency Form field Donation Amount requires format 1,000.00

Payment Amount + Donation Amount

Currency Form field Payment Amount + Donation Amount requires format 1,000.00

Credit Card Fees

The Payment Amount

Currency Form field The Payment Amount requires format 1,000.00

Convenience Fee

Currency Form field Convenience Fee requires format 1,000.00

Total amount to be charged

Currency Form field Total amount to be charged requires format 1,000.00

Credit Card Payment

Listed amount

Decimal Form field Listed amount requires format ##########.##

Do you agree to pay listed amount Value is not selected

Required

Credit Card Information *

Invalid credit card number and/or security code.

Incorrect expiration date.

Payment has to be processed first.

A payment field is present on the form, but payment support has not been set up.
Please get in touch with us.

Processor Calculation pt 1

Decimal Form field Processor Calculation pt 1 requires format ##########.##

Processor Calculation pt 2

Decimal Form field Processor Calculation pt 2 requires format ##########.##

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Online Payment Portal

Online Payment Portal

Credit Card Fees

Credit Card Payment