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Retainer Plan Payment Form
One Year Retainer Monthly Payment Form
Use this form to pay for a year long retainer for a project.
Invoice Reference
Name
*
First
Last
Company Name
*
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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New York
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Northern Mariana Islands
Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
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Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
Monthly Payment Amount
This amount will be charged to your credit card once per month for 12 months beginning today.
Monthly Retainer Payment
$0.00
Name
This field is for validation purposes and should be left unchanged.
1 Year Retainer Plan
Massive Impressions Online Marketing is an Authorize.net Approved Vendor
Merchant Services
Massive Impressions Online Marketing
Boca Raton, FL 33431
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