Payment Form

This Online Payment Form can be used for any type of payment due to Please be sure to enter your BUSINESS INFORMATION and PAYMENT AMOUNT as well as any other additional information that you feel is necessary.

Once you click the blue "Submit" Button, you will be directed to the PayPal payment page where you can securely enter your bank card information.

Credit card charges are billed securely
through PayPal and Data Services of Georgia

Business Name:
Contact Name:
Contact Phone:
Website Address:
Payment Amount:
Additional Info: