Regal Tech Virtural Pay

Credit Card Payment

 

Customer Information
 
*Customer Number Max of 6 digits
*Contact Name
*Card Holder First Name
*Card Holder Last Name
*Credit Card Billing Address
*Credit Card Billing City
*Credit Card Billing State
*Credit Card Billing Zip Code
*Phone #
*E-Mail (i.e. anyone@any.com)
*Verify E-Mail
(i.e. anyone@any.com)

 

Credit Card Information

 
*Credit Card Number


*Credit Card Exp. Month
*Credit Card Exp. Year
*CVV2 Security Code
amex code

 

Invoice Information

 
Please Choose:


Payment Message
*Required Field

Please Note: Your payment plus a 2% Convenience Fee will appear on your credit card statement as a charge from "Baker Distributing". By clicking on the button below you will be given the amount of the Convenience Fee and grand total before submitting the payment.

veri-sign

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