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ONLINE PAYMENT SYSTEM:

CHET HOLMES INTERNATIONAL, WEBSITE DESIGN DIVISION


I would like to make a payment to:

Chet Holmes International
4317 NE Thurston Way, Suite 200
Vancouver, WA 98662
(888) 815-9970

One-time Payment (Single Payment)
      Amount $ US Dollars.

Recurring Payments (Subscription monthly payments)
      Amount $ US Dollars.
      I authorize the above amount to be charged each month for payments.

Purpose:
Invoice #
New Project Deposit (Please enter a short description below)
Prepay for a work order (Please enter a short description below)
Regular monthly payments such as hosting or subscription service.

Description or Comments:


Billing Information:

Company Name:
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone #:
Email:
  Credit Card Information:

  Credit Card Type
Credit Card Number:
Credit Card Type:
Expired Date:
CVV: What is this?

   

Please note: The charge for this order will appear on your credit card billing statement as "Chet Holmes International".