Daggett County Cemeteries
             

Daggett County Cemeteries

Payment Amount:   $25.00   Quantity:   Item Subtotal:  
$0.00
Block and Lot Number [1]

Block and Lot Number

[2]

Block and Lot Number

[3]

Block and Lot Number

[4]

Block and Lot Number

[5]

Block and Lot Number

[6]

Block and Lot Number

[7]

Block and Lot Number

[8]

Block and Lot Number

[9]

Block and Lot Number

[10]
Total:
$0.00

Personal Information:
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
Payment Information
Method of Payment:
Processing Fees: Credit cards: 2.5% ($2.50 min)
                    (+1.5% processing fee for foreign cards)
eChecks: $0.75
Update name from Personal Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number: (Type number or swipe with cursor in this empty field)
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Personal Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:
Please be aware that credit card payments will reflect on your statement as
County UT 8007640844 ClintonUT
 
Use Instant Payments to accept payments for your business.
SIP Program & Data © 2006-2018 Instant Payments All rights reserved.
~ Terms & Conditions ~ Privacy Policy ~ Contact Us ~
SIP Version 2.18; API: 2.5
RSI Security Instant Payments, Payment Processing Service, Clinton, UT Get Help