Online Payment Form

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BUSINESS COMMUNICATION NETWORK SYSTEMS

(800) 319-9087

 

Printable Payment Form

For Visa and MasterCard Payments

Visa Mastercard Accepted

Please call our accounting department at (800)319-9087 option 3 with your payment information or

print a copy of this form, fill out all information and return to TSM South by fax or mail.

All fields are required.

  

APPROVAL TO PAY INVOICE # : ___________________

IN THE AMOUNT OF $ : ____________________

CREDIT CARD # : ____________________

EXPIRATION DATE :  ____________________

SECURITY CODE (CVV2 - 3 digit code on back of card) : ____________________

NAME ON CARD : ____________________

ADDRESS WHERE CREDIT CARD STATEMENTS ARE MAILED: ____________________

EMAIL OR FAX# FOR RETURN RECEIPT : ____________________

 

Please sign and return completed form to TSM South via fax or mail.

Fax # 919-854-4613 (Accounting Fax) or 919-854-4612 (alternate fax)

Mailing Address:

PO Box 2137, Cary, NC 27512

 

Questions?  Contact Lauren (919-532-5373)

 Download Payment Form

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Payment Form