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Number of Invoices
(Required)
1
2
3
4
How many invoices are you paying?
Invoice #1
(Required)
Invoice Number
Invoice #1 Amount
(Required)
Invoice #2
Invoice Number
Invoice #2 Amount
Invoice #3
Invoice Number
Invoice #3 Amount
Invoice #4
Invoice Number
Invoice #4 Amount
Total
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Supported Credit Cards: MasterCard, Visa
Card Number
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Date Sent
MM slash DD slash YYYY
The date payment was sent
Orginating Bank Account
Originating bank account payment was sent from
Account Name
Name of the account that payment was sent from
Wire Transfer
Contact your bank if you need assistance, and please make sure to cover all related charges on your end. Also, ensure that the payment is sent as a
bank wire
only, not an ACH, EFT, or e-check.
Please make sure to pay any fees your bank charges for the transfer, and do not subtract the associated wire fees from your payment to us. In the wire transfer payment notes, please include your invoice numbere for your account so we can easily look up your payment and get it applied to your account faster.
Domestic Wire Transfer
Beneficiary
Beneficiary Name
TheServerDoctor LLC
Account Number
202264693969
Type of Account
Checking
Beneficiary Address
3814 Highbridge RD, Fairfax, VT 05454
Receiving Bank
ABA Routing Number
091311229
Bank Name
Choice Financial Group
Bank Address
4501 23rd Avenue S Fargo, ND 58104
International Wire Transfer
Receiving Bank
SWIFT / BIC Code
CHFGUS44021
ABA Routing Number
091311229
Bank Name
Choice Financial Group
Bank Address
4501 23rd Avenue S Fargo, ND 58104 USA
Beneficiary
IBAN / Account Number
202264693969
Beneficiary Name
TheServerDoctor LLC
Beneficiary Address
3814 Highbridge RD, Fairfax, VT 05454 USA
Payment Terms
(Required)
By submitting for payment, you agree to the following:
Payment Terms:
1) Payments will be applied to the invoices as stated. If no invoice number is provided, payments apply to the oldest invoice first.
2) You are the authorized account holder for the payment method.
3) The information on this form and your IP address will be collected and stored as outlined in our Terms of Service.
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