Billing Information  
 
  
Your Account Number
  
Company Name (optional)
  
First Name
 
MI
 
Last Name
   Address
  
  
City
  
State
  
Zip Code
  
Phone
  
Work Phone
  
E-mail (required for an emailed receipt)
  
 
   Payment Information  
  

Payment Amount
 
  Please select a payment method
Checking Savings Credit/Debit Card
  Notes

 
 
Notice

Terms & Conditions: We will only collect personally identifiable information (such as name, title, company name, address, telephone number or e-mail address) that you voluntarily provide through our web site or e-mail correspondence. Before we collect any personally identifiable information, we will provide an explanation for the possible use of your data. The information you supply will be used by us to respond to your inquiries or requested information. It may be necessary, if required by law or if pertinent to judicial or governmental investigations, to release your personally identifiable information. If you have submitted personal information to us electronically and would like it removed or modified, please contact us. We will use reasonable efforts to comply with your request. The actual transmission of your payment information over the Internet is at its safest when your web browser can make an encrypted connection; we will only process your order if you can make such a connection. If you have trouble with the encrypted connection, your computer, web browser, or internet connection cannot support SSL (Secure Socket Layer), then contact us to complete your order. Bills are net and due the first of each month. A penalty of 10% will be added if not paid on or before the 15th. Payments not made by noon on the 16th will receive a notice of disconnect. A charge of $30 will be made for all reconnections. Please ensure you provide your email address so that we can confirm your payment was received. Thank you!


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