Billing Information:
First Name
*
Last Name
*
Address
*
Address Line 2
City / State
*
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
*
Phone Number
Email Address
By providing your phone number or email you are authorizing Summit A*R to contact you if an issue arises with your credit card or bank account payment and/or to send you a copy of your receipt via email
Credit Card Information:
Use same name and address as above
Name as on Card
*
Card Billing Address
*
Card Billing Zipcode
*
Card Type
*
Visa
MasterCard
American Express
Discover
Card Number
*
Expiration Date
*
MMYY
Security Code
*
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Payment Amount
$
Account Number
*
(Include the leading zero's)
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Notes (optional)
By clicking continue, you are authorizing the transaction amount entered above to be charged to your credit/debit card or bank account. This transaction will be credited to the account number you've entered above.