Approved
Name:
Amount:
Card Type:
Card Number:
Authcode:
AVS Result:
CVV Result:
OK
OK
Cancel
Credit Card Details
Pay with Check
Card Number
*
MMYY
*
CVV
?
Transaction Details
Choose or Enter an Amount
$1,000
$750
$500
$250
$100
$75
$50
$25
Description
Recurring Payments
Schedule
Monthly
Weekly
Ongoing Monthly
12 Months
18 Months
24 Months
36 Months
Ongoing Weekly
1 Year
2 Years
Personal Information
Full Name
*
Address
Zip code
Phone Number
Email Address
*
Process Payment
Processing By
Merch Pay, Inc. is a registered ISO of Wells Fargo Bank, N.A., Concord, CA.
merchant login
merchant login
merchant login
merchant login
Credit & Debit Processing | Electronic Check Services | Gift & Loyalty Programs | Customized POS Solutions
UJGC
400 Rella Boulevard
Montebello, NY 10901
Tell: (347) 228 - 2915
[response]
ID #[transid]
[created]
[cardholder]
$ [amount]
[cardtype] [ccnum4]
Authorization Number
[authcode]
AVS Response
[avsresult]
CVV response
[cvcresult]
[otherTransaction]
