IDFAX - Credit Card Payment Services

I D F A X can be reached at:
phone/fax: (860) 286-0249 ||| e-mail: services@idfax.com
38 High Hill Road, Bloomfield, CT 06002

CREDIT CARD PAYMENT SERVICES

Dear Client,

Please verify the services you are requesting and the correct payment for the services by reading the Contracts sent to you. For any questions or clarifications, please contact IDFAX before submitting payment.

This form can be used with any version of Internet Explorer browser, any version of AOL browser, and Netscape Navigator 4.7 or earlier browser versions only. If you are unable to use this form, please contact IDFAX.

Client's Name:
Date of Birth:	[please use numbers only, in the following format: mm/dd/yy]

Please enter the correct payment amount:
	Translation Services	$
	Medical-Legal Expert Services	$
	Other Services	$

	Enter the Total Amount:	$