FORM OF PAYMENT
Check (no invoice)
If you wish to pay by credit card, please complete the information below: Credit Card Type:
Credit Card Number:
Name on the Card: Billing address for the Card:
Signature: If you would like to set up automatic payments, please contact firstname.lastname@example.org for an enrollment form.
If you wish to pay by Bank wire, please use the information below: Beneficiary: Cornerstone Information Systems, Inc. 304 W. Kirkwood Ave, Suite 4 Bloomington, IN 47404 Checking account # 0087509091 Receiving Bank: Regions Bank #374 Bloomington, IN 47404 ABA Routing # 062005690 Swift Code: UPNBUS44
This is our Form of Payment Document for customers to fill out