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Secure Payment Form

           
Payment Date
Payment Type
Customer Name
Agent Name
RETX #
Apartment Address
Comments/Notes
Payment Amount
Technology Fee (3.5%)
Total Payment Amount
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Phone Number
Email Address (For your receipt)
Customer IP

Note:

All Monies presented are non-refundable unless application is denied by the landlord.

Application Fees are non-refundable in all circumstances

The Technology Fee is non-refundable on all transactions.