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IMPORTANT:
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- Please have your CPLS File No. from your statement available before making a payment.
- Payments processed after 6:00 p.m., and on weekends, will not be posted until the following business day.
- By completing this form, you are authorizing CPLS to use this card to pay for the legal services being provided to you, person, and/or business entity listed in the Client Name field of this payment form.
- All payment amounts are processed in U.S. dollars.
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Payment Information:
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| Payment Date:
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01/17/22
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*Client Name:
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*Client Type:
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*File Number:
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(Enter the number exactly as it appears on your invoice including dashes _ _ _ _ - _ )
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| Invoice Number.:
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*Payment Amount:
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Charge Amount:
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Credit Card Information:
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*Card Type:
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*Card Number:
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*Card Expiration
Date:
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MMYY
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*Card ID (CVV2/CID) Number:
[What is the Card
ID?] |
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*Cardholder Name
(Name as it appears on card):
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| *Card Billing Address:
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| *Card Billing City: |
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| *Card Billing State: |
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| *Card Billing Zipcode: |
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| *Email Invoice To: |
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*I agree to the Terms and Conditions:
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By submitting this form, you hereby authorizes CPLS, P.A. to charge against said card the following one time charge for legal services and/or costs provided to and/or on behalf of the above client. Your agreement to pay the Client’s fees and costs does not authorize CPLS, P.A. to disclose any information to him/her about the Client without the Client’s approval. |
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THE CENTER FOR PROFESSIONAL LEGAL SERVICES
201 E. Pine Street, Suite 445, Orlando, FL 32801 407.647.7887 Tel. 407.647.7887 Fax
www.cplspa.com
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