CC – Figment Design

CLIENT INFORMATION
COMPANY NAME*
INVOICE OR QUOTE NUMBER*
Write in N/A above if making extra payment or you do not have an invoice or quote number available.
CONTACT PERSON FIRST NAME*
CONTACT PERSON LAST NAME*
PHONE NUMBER*
EMAIL*

This is where your payment receipt will be sent to.
WEBSITE ADDRESS
Example: http://www.figmentdesign.com
BILLING ADDRESS*
Street Address City State / Province / Region ZIP / Postal Code Country
Amount Due*

Please add the payment amount above based on supplied invoice or quoted price.
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
QUESTIONS? CONTACT: Figment Design at (305) 593-7488 or email accounting@figmentdesign.com

Payment Gateway

This is a secure gateway for Credit Card payment.
Please fill out all information correctly for card verification.
Enter the exact amount of your payment and double check before submitting. Enter the Invoice number for reference or a subject line for reference.

Only hit submit once to avoid a double billing. You will receive a thank you for your payment email. Figment Design is PCI compliant and we do not keep any credit card information on file.

CLIENT INFORMATION

Payment Gateway