Please Enter Your Billing Information Below:
Required fields are marked with an asterisk (*).
NOTICE: It is the policy of Plug & Pay Technologies, Inc. to respect the privacy of its customers and the people doing business through its service. As such all information presented here WILL NOT be sold or distributed to any party other than the merchant you have currently elected to do business with.
 
Amount to Pay:*
Name:*
Billing Address:*
Line 2:
City:*
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International Province:
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Country:
Card Type:
Visa Mastercard
Credit Card #:*
Exp. Date:*
Email Address:*
Day Phone #:
Night Phone/FAX #:
Comments or Special Instruction:
Privacy & Security Policy