Credit Card Payments – The Laurel Group

Cards Accepted

Bill Pay Authorization – Credit Card Payments

Information and instructions. To schedule your payment to be charged to your credit card (Visa, MasterCard, American Express or Discover Card), please complete the form below. A 4% processing fee will be applied to all credit card payments. By completing and submitting this form, you authorize The Laurel Group to complete transactions for amounts due as per a signed contract or agreement for projects or maintenance.

Laurel Group Payment Authorization Form CC

First Name*
Last Name*
Email*
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Invoice & Payment Information
Please complete this section to indicate the invoice and value to apply. Please also note if there are any special instructions.
Invoice Number(s)
Amount To Be Paid
Credit Card Information
Please complete this section for payments made through credit cards.
Cardholder Same As Customer Information
Cardholder First Name
Cardholder Last Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card Type
Expiration Month
Expiration Year
Account Number
Security Code
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Bill Pay Authorization – Credit Card Payments

Laurel Group Payment Authorization Form CC

Invoice & Payment Information

Credit Card Information

Huntington

Roslyn

Hamptons