Sales@InstantPayments.com                                                 www.InstantPayments.com
Customizable Shopping Cart Solutions In Minutes:
  • Payment of Invoices   
  • Special Events - Marathons, Bikeathons, etc.
  • Collection of Dues
  • Registrations
  • Surveys
What kind of payments do you accept?
Methods of Payment you need:
Visa/MasterCard/Discover
American Express
eCheck (ACH)
None - surveys/registration only
Personal Information:
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
When Is the Best Time to Contact You?
Early Morning
Afternoon
Evening
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