Pay with credit card
We value the security of your information. Due to security issues that some companies have been experiencing with credit cards, we have made the decision not to accept credit card information online at this time. Premier Reporting, LLC accepts payment by Visa, Mastercard, and American Express credit cards via U.S. Mail or fax. For your convenience, this form can be filled out, printed, and sent to us.
Please fill out the following information. The information with an * is required to process your payment. After completing the form, fax it to: Premier Reporting, LLC at 717-243-0413 or send it via U.S. Postal Service to: Premier Reporting, LLC, P.O. Box 186, Carlisle, PA 17013. A receipt will be sent as soon as we receive this form and process payment.
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* Your Name:
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* E-mail:
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Law Firm Name:
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* Attorney Name:
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* Street Address:
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* City:
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* State:
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* Zip:
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* Phone:
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Fax:
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* Date of Deposition:
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* Premier Reporting invoice
number:
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Case
caption:
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vs. |
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* Credit card type:
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Visa Mastercard American Express |
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* Credit Card Number:
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* Credit Card Expiration Date:
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* Name on Credit Card:
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* Credit card billing address if different from above address:
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* Security Code:
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Other
requests & comments:
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* Amount to be charged:
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_______________________ |
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* Today's date:
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_______________________ |
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* Authorized Signature:
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_______________________ |
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* Required information |
For your convenience Premier Reporting, LLC accepts credit card payments by Visa, Mastercard, and American Express.