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USER CONTROL PANEL
Payments

USD MVR Account Information
MVR Account Number  
User Name  
Password  
Customer Information
E-mail    

Credit Card Information
CC Issuer
Card Number  
Card Expiration /
Cardholder Name Exactly
as it Appears on Card		  
Clients name same as Cardholder
First Name  
Last Name  
3 or 4 digit code located
on back of credit card		  
Payment Amount  
Customer Information
E-mail    

Checking Account Information

Account Type
First Name
Company
    
Last Name  
Address 1
Address 2
City
State
Zip

Bank Account Details
Bank Name
Check Number (?)
Routing Number (?)  
Account Number (?)  
Payment Amount  
PLEASE READ BEFORE SUBMITTING YOUR CHECK PAYMENT:
If your check is returned for Insufficient Funds a $25.00 Fee will automatically be deducted from your MVR Account.

If incorrect MVR account or Checking Account information is entered and submitted via this payment form a $10.00 Fee will automatically
be deducted from your MVR Account. Please check your entries before clicking the Submit button and processing your payment.
Copyright 1995-2004 United Software Developers Inc.
1718 Jerome Ave., Brooklyn NY 11235 Phone: 800-353-3755