Invoice Payment Authorization

Invoice Payment

Authorization Form

Please complete the below information to retain services.

Customer Information (As it appears on credit card)

Billing Information

City

State

Zip

Card #

Card Expiration Date

Verification Code

Check One

Visa

Master Card

Discover

American Express

Amount

Comments (Invoice # if applicable. And please let us know if you'd like us to retain this card for future use.)

Payment Form Agreement

By submitting this form, I authorize Halo CFO, LLC and its authorized credit/debit card transaction agent(s), to bill my credit/debit card account for monthly recurring payments, and/or other services.

I also understand that I am responsible for any declined/returned payments, and may be subject to any interest, or fees accordingly. I understand failure to pay my bill may result in the reversal of all discounts and interest charged at 1.5% for each month or part thereof in the past due balance.

I understand and agree I have or will receive (d) adequate services or product and that I owe for said services.

Enter the amount you wish to pay:

Thank you for your payment!

and

Thank you for choosing Halo CFO & Tax!