One Time Payment | Bert’s Paint Payments

Payment Details

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Customer Name*

Customer Account Number*

Additional Payment Instructions*

Total Payment Amount*

Attach Remittance Detail

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Email*

Phone*

Billing Address*

Street Address Address Line 2 City State ZIP Code

Secure Credit Card

Card Holder*

Card Number*

Card Expiration*

Card CVV*

Convenience Fee 2%

$0.00

Total

$0.00

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