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MAKE PAYMENTS

Use this form if you are an existing client who would like to pay your invoice online.

Required fields are marked with an asterisk (*).

If you have any problems or errors using this form, please contact Michele Jenkins at (302) 731-5200 or mjenkins@dinglekane.com


CONTACT INFORMATION

*Client Name:
*E-mail Address:
*Phone Number:
Fax Number:


BILLING INFORMATION

Please enter your credit card data in the fields provided

*Name, as it appears on card:
*Billing Address:
*Billing City:
*Billing State:
*Zip Code:
*Select a credit card: VISA MasterCard
Discover American Express
*Credit Card Number:
*Expiration Date:
*Security Code:
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*Amount of Charge: $Note: Charge must be $100 or more.
*Comments to describe payment: