Online Payment Page

Online Payment Page for Eximus solutions inc

Instructions:

* This payment page is hosted on a secure website with SSL encryption.
* Please enter all fields marked with a (*) and a red input box.
* If paying from a business or corporate banking account, please enter the company name in both "First Name" and "Last Name" fields.
* To receive an emailed receipt, you must enter your email address.
* Please contact the administrator if you have any questions.

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone Number

Notes

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