Admin Payment

This form is for administrative use only, for entering client payment information after receiving via phone or in person. Remember you're handling sensitive information!

Administrative Client Payment
We'll get the client's name below; here we want to know who is submitting the information on behalf of the client.
WESST Staff/Contact Name
WESST Staff/Contact Name
First
Last
Payment Amount
Credit Card
Might be same as cardholder name, above, but this one allows us to send a personalized message that payment was submitted (they will also get a receipt from Stripe that payment was accepted).
Client Name
Client Name
First
Last
First
Last
Enter Email
Confirm Email
Billing Address
Billing Address
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Total