ONLINE PAYMENT SUBMISSION
PMX Invoice #:
Payment Amount:
Name as it appears on card:
PLEASE NOTE:
DO NOT
PAY MULTIPLE INVOICES WITH THIS FORM.
WE CAN ONLY ACCEPT ONE INVOICE PER PAYMENT
SUBMITTED.
USE A NEW PAYMENT FORM FOR EACH INVOICE.
We can handle multiple payments over the phone if you
wish. (763) 783-7103. Ask for Gina.
Thank you for your business!
The PMX team.
Street
:
Unit/Apt./etc.
:
ZIP:
Visa M/C Discover
Card Number:
EXP:
CVV2:
Phone:
The 3 or 4 digit CVV2
code is located to the
right of your signature.
Email:
Questions, comments, or feedback:
