Resurgence Legal Group, PC
Secure Payment Form
Payment Summary
Payment Date
Payment Amount
Reference Number
All payments must include your Reference Number which will start with TP, R, RN, MN, CA, or WI.
Description
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Disclaimer
I,
, authorize Resurgence Legal Group, PC to charge my credit card above in the amount I entered above and such payment will be applied to the account entered in the Reference Number field.
Submit
