Payment Portal

Invoice Payment

Form to submit electronic payment

Name(Required)

First Last

Company Name(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Invoices(Required)

How many invoices are you paying?

Invoice #1(Required)

Invoice Number

Invoice #1 Amount(Required)

Invoice #2

Invoice Number

Invoice #2 Amount

Invoice #3

Invoice Number

Invoice #3 Amount

Invoice #4

Invoice Number

Invoice #4 Amount

Total

Payment Method(Required)

PayPal

Credit Card

Wire Transfer

Payment Method

Credit Card

Card Details

Cardholder Name

Date Sent

The date payment was sent

Orginating Bank Account

Originating bank account payment was sent from

Account Name

Name of the account that payment was sent from

Wire Transfer

Contact your bank if you need assistance, and please make sure to cover all related charges on your end. Also, ensure that the payment is sent as a bank wire only, not an ACH, EFT, or e-check.

Please make sure to pay any fees your bank charges for the transfer, and do not subtract the associated wire fees from your payment to us. In the wire transfer payment notes, please include your invoice numbere for your account so we can easily look up your payment and get it applied to your account faster.

Domestic Wire Transfer

Beneficiary
Beneficiary Name	TheServerDoctor LLC
Account Number	202264693969
Type of Account	Checking
Beneficiary Address	3814 Highbridge RD, Fairfax, VT 05454
Receiving Bank
ABA Routing Number	091311229
Bank Name	Choice Financial Group
Bank Address	4501 23rd Avenue S Fargo, ND 58104

International Wire Transfer

Receiving Bank
SWIFT / BIC Code	CHFGUS44021
ABA Routing Number	091311229
Bank Name	Choice Financial Group
Bank Address	4501 23rd Avenue S Fargo, ND 58104 USA
Beneficiary
IBAN / Account Number	202264693969
Beneficiary Name	TheServerDoctor LLC
Beneficiary Address	3814 Highbridge RD, Fairfax, VT 05454 USA

Name

This field is for validation purposes and should be left unchanged.

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Invoice Payment

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