Credit Card Payment Submission Form

This can be used by the Renovation Specialist and/ or the Customer to establish limited vision and access to credit card information. If your contract/ proposal was quoted for an electronic check or debit card payment and you enter a credit card for payment you will be charged a 3% credit card processing fee. So you may stop at this time and call Sandra Adams if you have any questions or concerns. She may be reached 678-471-5827 or sandra.adams@lrenovations.com.

Date Entered

This transaction may be post dated if necessary for the transferring of funds. Please put any detailed information in the next field "Comments to Processor".

Comments for Processor

If your credit cards needs to be held until a specific date because you are transferring funds etc. Please put your instructions for it's processing here. It can several days for your credit to process.

Project Name*

If this is deposit please enter the Project Name (the signer of the Contract). If this is for a job in process lease enter the Job # listed on the invoice. If payment is for multiple jobs please enter all associated. Thank you for your kind assistance.

Email:*

This is the email that you would like your receipt for processing to be delivered.

Card Holder*

Card Number*

Please do not enter any dashes or spaces. Enter numbers only.

Street Address where card's billing is delivered

This is the address where the customer receives their bill for this card. It may not be the address of the property. It may be a PO Box as well.

SEC or VCode*

This is the 3 digit code from the back of the card if Visa or MasterCard. The 4 digits from the front of the card if an Amex.

Billing Zip Code*

This is the Zip Code of the Billing Address of the card being used.

Expiration*

Please enter in MMYY format. No special character.

Credit Card Type

Select or enter value

Amount*

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