Collier Companies

Clear Card Information

Name on Card *

Card Number *

Security Code *

Exp. Month

Exp. Year

(all fields required unless noted)

First Name *

M.I. (optional)

Last Name *

Address 1 *

Address 2 (optional)

City *

State

Zip Code *

Phone (for billing-related questions) *

Disclosures

We impose a surcharge on credit cards that is not greater than our cost of acceptance. This surcharge rate is 3.50%. This surcharge is not applied on debit card or ach transactions.

I have read and accept the above disclosures.

E-mail for Confirmation

E-mail Address

Your privacy is important to us
This is just for confirmation of payment

Confirm E-mail Address

Invoice/Ref #:

Payment Amount: * *

Service Fee Details

Card Present

Fee:

Total:

Card Not Present

Fee:

Total:

This site is secure.
Your security is important to us.

* Required Field

Need help? Contact Support