Payment Form — Preferred Mortgage Choice

Credit Card Form

Please Note the charge on your card will show “Professional Services” or “PMC”

Please note, there will be a 4% service fee from the service provider.

Name

First Name

Last Name

Phone

(###)

###

####

Credit Card Number

Expiration date

CCV

Dollar amount

By checking this box, I agree to let PMC charge my credit card for the amount specified above. I acknowledge that there will be a 4% service fee from the credit card service provider for this transaction.

I agree

Billing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country