Law Offices of John T. Orcutt Payment Page

If so, please fill in the following required information. Then, click on the “Submit” button.

IMPORTANT: Do NOT use to pay your Chapter 13 plan payments. After filing, those need to be paid directly to your Chapter 13 Trustee.

Information About Client

Full name of client(s) *

Office location visited *

Who is/are the client(s)
working with at our office?

Billing Information Regarding Owner of Credit/Debit Card

Your First Name *

Your Last Name *

Your Address *

City *

State *

Zip/Postal Code *

Your E-mail

Your best phone number
(Including area code) *

example: (555) 555-5555

Your 2nd best phone number
(if any)

Purpose of your payment *

Payment Information

One payment

Multiple payments

Payment amount

Upfront amount

Recurring amount

Recurrent starting date

Month

Day

Year

Payment Frequency

Number of payments

Credit Card Information

Card Number *

Name on card *

Expiration Date *

Month

Year

Security Code on card (CVV) *

For Visa and MasterCard cards, the card code is the last 3 digit number located on the BACK of your card on or above your signature line.

For American Express card, it is the 4 digits on the FRONT above the end of your card number

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