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Agreement and Payment Authorization
You acknowledge and agree that you are authorized to use this payment method. You are authorizing BITS or BITS Payment Processing Affiliate to process this payment in the amount specified.
Select Card Type
- Select a value -
MasterCard
Visa
American Express
Discover
other
Please indicate the type of payment card you are using.
Name on Card
Please input the name as it appears on the payment card.
Card Number
Please fill in your credit or bank card number.
Expiration Month
01
02
03
04
05
06
07
08
09
10
11
12
Please indicate the card expiration month.
Expiration Year
- Select a value -
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Please indicate the payment card expiration year.
Billing Zip Code
Please fill in your billing zip code for this payment form.
CVV Security Code
Please input your card cvv or security code usually found on the back of the payment card.
Invoice Number
Please input the invoice number that this payment should apply to.
Notes or Comments
Payment Amount
Please fill in the payment amount for this payment in US dollars and cents.
Payment Phone Number
BITS Account Number
Please input your BITS account number and AAN (account access number). This number can be found on your invoice.
Leave this field blank