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FORM OF PAYMENT

Check (invoice)

Check (no invoice)

Credit Card

Bank Wire

If you wish to pay by credit card, please complete the information below: Credit Card Type:

Visa

Master Card

American Express

Credit Card Number:

Expiration Date:

Name on the Card: Billing address for the Card:

Signature: If you would like to set up automatic payments, please contact accounting@ciswired.com 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

Form of Payment  

This is our Form of Payment Document for customers to fill out

Form of Payment  

This is our Form of Payment Document for customers to fill out

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