We need a Payments Form developed for our new website. This is beyond the scope of our site developer's ability, so you'll need to work with him on this page. The form will have all the required fields below. The site needs to be secure (I'm not sure what we'll need for that, but would like to hear suggestions). If one of the fields is not filled in, the page needs to say which one is not filled in correctly. The form will send an email to us with the information. Also, right next to the form will be a picture of a sample bill with a circle around the Invoice Number or Bill Payer ID Number so they can find it to put it into the form.
* First Name
* Last Name
* Phone Number
* Location of service (address)
* Invoice Number OR Bill Payer ID Number
* Amount $ + $[url removed, login to view] convenience fee
* Credit Card Type (Select Visa Mastercard American Express Discover)
* Credit or Debit Card Number
* Expiration Date (with Month / Year dropdowns)
* Security Code
* Billing Zip Code
We have much more work to do for the right person - please submit bid ONLY IF YOU ARE AN EXPERT IN THIS AREA and can offer us a secure solution.