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Online Payment Form 2018-08-17T16:30:43+00:00

Online Payment Form

BUSINESS COMMUNICATION NETWORK SYSTEMS

(800) 319-9087

Printable Payment Form For Visa and MasterCard Payments

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 # 919-854-0412 (Accounting Fax)

Mailing Address:

PO Box 2137, Cary, NC 27512

Questions?  Contact Lauren (919-532-5373) 

Payment Form

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