Common Checkout Payment Entry

Transaction Detail

Description	Unit Price	Quantity	Amount
Certificate of Status	$20.00	1	$20.00
Personal Property Return	$20.00	1	$20.00
Articles of Incorporation	$20.00	2	$40.00
Trade Name Registration	$20.00	3	$60.00
Expedited Fee			$60.00
Service Fee			$7.20
Total			$267.20

Payment

Payment Type

Customer Information

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Country

First Name

Last Name

Address

Address 2

City

State

ZIP/Postal Code

Phone

Payment Information

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Credit Card Type

Name on Credit Card

Credit Card Number

Security Code

Expiration Month

Expiration Year

Account Type

Routing Number

Account Number

Re-enter Account Number

Name on Account

Select if this payment IS being funded specifically by a FOREIGN source (bank or company), an International ACH Transaction (“IAT”).

As defined by NACHA, IAT means a credit or debit entry that is part of a payment transaction involving a financial agency's office that is not located in the territorial jurisdiction of the United States. For purposes of this definition a financial agency means an entity that is authorized by applicable law to accept deposits or is in the business of issuing money orders or transferring funds. An office of a financial agency is involved in the payment transaction if it:

Holds an account that is credited or debited as part of the payment transaction;
Receives payment directly from a Person or makes payment directly to a Person as part of the payment transaction; or
Serves as an intermediary in the settlement of any part of the payment transaction.

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Transaction Summary

Transaction Total

$267.20