Payment Information Submit your information for invoice payment. Credit Card Authorization Form Payment "*" indicates required fields Δ Name* First Last Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email*Invoice/Reference Number*Amount*Select A Card TypeVisaMasterCardAmexCredit Card number*Exp. Date*Code on back*Please set up my account for automatic payment Yes Billing Name and Address Same As Above Account Name and Address* Account Name Account Address City State / Province / Region ZIP / Postal Code By submitting this form you authorize Imperial Cleaning Corporation d/b/a Global Services to charge your credit card as indicated above.* Yes, I agree PhoneThis field is for validation purposes and should be left unchanged.
