Payment

Your Name(Required)

First Last

Your Title(Required)

Your role at the company you represent.

Your Email(Required)

Your Phone(Required)

Company Billing Address(Required)

Street Address City State ZIP Code

Payment Type(Required)

What type of payment would you like to set up today?

eCheck/ACH Payment

This form is used for Automated Clearing House (ACH) payments to provide payment-related information to your financial institution. By submitting this form you agree to the stipulations in the Authorization Agreement for Automated Clearing House Transactions. You must check with your financial institution to confirm that funds have been withdrawn. Transactions are negotiable for only 90 days. You can also download the form and mail it in to Partnered Solutions IT, 58 W 11th Ave, Eugene, OR 97401.

Company Name(Required)

As it appears on your bank account.

Bank Name(Required)

As it appears on your bank account.

Routing Number(Required)

Enter your 9-digit routing number.

Account Number(Required)

Review it for accuracy.

Account Type(Required)

Please select the account type.

Payer / Authorized Official(Required)

Payer Title(Required)

Invoice Number(s)(Required)

One-Time Payment Amount(Required)

ACH Authorization Agreement(Required)

If you would like to review the ACH Agreement Terms and Conditions page (in a new window) before authorizing, click here.

By completing this form, I agree to the ACH Agreement Terms and Conditions as presented by Phoenix Business Solutions, LLC. I certify that I am an authorized signor on this Depository Account.

One-Time Credit Card Payment (4% Fee)

Company Name(Required)

Optional Invoice Number(s)

One-Time Payment Amount(Required)

Total

Credit Card(Required)

Card Details

Cardholder Name

Account / Payment Notes

Please include in this space anything else you would like for us to know about your account or payment.

Recurring Credit Card Payment

Company Name(Required)

Name on Credit Card(Required)

Credit Card Number(Required)

Expiration Date (MM/YY)(Required)

CVV Number(Required)

The 3-digit CVV is located on the back of the card. If you are using AMEX, the 4-digit CVV is on the front.

Account / Payment Notes

Please include in this space anything else you would like for us to know about your account or payments.

Credit Card Authorization Agreement(Required)

By submitting this form, I authorize Phoenix Business Solutions, LCC to charge my credit card above for agreed upon purchases on the day invoices are due. I understand that my information will be saved to file for future transactions on my account.