IMPORTANT:
 
  • Please have your PCC 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 Private Corporate Counsel 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.
Payment Information:
Payment Date: 06/10/23
*Client Name:


*Client Type:
*File Number:
(Enter the number exactly as it appears on your invoice including dashes _ _ _ _ - _ )
Invoice Number.:
*Payment Amount:
Charge Amount:
Credit Card Information:
*Card Type:

*Card Number:
*Card Expiration Date: MMYY
*Card ID (CVV2/CID) Number:
[What is the Card ID?]
*Cardholder Name
(Name as it appears on card):
*Card Billing Address:
*Card Billing City:
*Card Billing State:
*Card Billing Zipcode:
*Email Invoice To:
   

*I agree to the Terms and Conditions:

 

 By submitting this form, you hereby authorizes Private Corporate Counsel 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 Clients fees and costs does not authorize Private Corporate Counsel to disclose any information to him/her about the Client without the Clients approval.


PRIVATE CORPORATE COUNSEL
201 E. Pine Street, Suite 445, Orlando, FL 32801 Tel. 407.647.7887 Fax 407.647.5396 privatecorporatecounsel.com