Payment Page

For your convenience, we accept Visa, MasterCard and American Express.* Please complete the form below to make the payment.


Please select the method of payment:
*2.5% convenience fee will apply all credit card transactions. You can avoid the convenience fee by choosing the Bank Account (ACH) payment method.

Cardholder Name _____________________________________________

Card Number _____________________________________________

Expiration Date ____________

CVV (3 digit number on back of Visa/MC or 4 digit on AMX) ______

Phone Number _____________________________________________

Email address _____________________________________________

[You can put card number and exp date fields side by side and same for phone and email address. I want the form to look short.] By submitting your payment information to us and clicking "Submit Payment," you agree to pay the amount indicated above. [Submit Payment] [For Bank Account, display the following] Amount: __________________ Invoice number (if applicable): _____________ Account Type: Business Checking Personal Checking [checkbox; allow only one to be selected] 
Accountholder’s Name _____________________________________________ Account Number _____________________________________________ Routing Number _____________________________________________ Phone Number _____________________________________________ Email address _____________________________________________ [you can put the Account number and routing number fields side by side; same for phone and email address. I want the form to look short.] By submitting your payment information to us and clicking "Submit Payment," you agree to pay the amount indicated above. [Submit Payment] [After information is submitted, display the following:] “Thank you for submitting your payment information. Your receipt will be emailed to you.” [all fields require input] [I want the access url to be www.q-a-law.com/pay]