[et_pb_section admin_label=”section”] [et_pb_row admin_label=”row”] [et_pb_column type=”4_4″][et_pb_text admin_label=”Text”] Payment arrangement online form Identification* First name Last name Phone number*Email* Email Confirm email Type of payment* Pay my balance Make regular payments Payment method* Pre-authorized payments Wire transfers Credit card Choose between simplified / pre-authorized payments or start making regular wire transfers. In all cases, specify how often you will make your payments.Void check/PAD* Drop files here or Select files Max. file size: 128 MB. Payment amount* $ 20.00 $ 50.00 $ 100.00 $ 150.00 Other Make sure you are able to pay that amountOther amount* payment frequency*WeeklyBiweeklyMonthlyChose payment frequencyFirst payment date* DD slash MM slash YYYY ** Please note that if you have chosen the "pay my balance" field, it will not be a recurring payment ** [/et_pb_text][/et_pb_column] [/et_pb_row] [/et_pb_section]
