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* 1. Client Information

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* 2. Payment of invoices must include 3% additional to cover processing fees.  Calculate your payment amount by multiplying the invoice total by "1.03" and include the total in the box below.  Payment amounts must be rounded to the nearest dollar.  Maximum limit $10,000 per transaction.

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Minimum amount: $1 USD
You will pay at the end of this survey.

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* 3. Please provide your invoice number here and any relevant information you would like to share about this payment.  Your card information will be securely collected after you click "done" below.  Thank you!

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