Collier Companies
Card Type
- - - -
American Express
Carte Blanc
Diners Club
NOVUS Discover Card
JAL
JCB
MasterCard
Visa
Clear Card Information
Name on Card
*
Card Number
*
Security Code
*
Exp.
Month
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Exp.
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Account Number
*
Routing Number
*
Check Number
(all fields required unless noted)
First Name
*
M.I.
Middle Initial
(optional)
Last Name
*
Address 1
*
Address 2
(optional)
City
*
State
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
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Indiana
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Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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.
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E-mail Address
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This is just for confirmation of payment
Confirm E-mail Address
Invoice/Ref #:
Service Fee:
Payment Amount:
Total w/Service Fee:
Surcharge:
Total w/Surcharge:
Service Fee Details
Card Present
Fee:
Total:
Card Not Present
Fee:
Total:
Surcharge Notice
We impose a surcharge on credit cards that is not greater than our cost of acceptance. This surcharge rate is 3.00%. This surcharge is not applied on debit card or ach transactions.
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