Customer:
Invoice #:
Payment Amount:
$
1
2
3
1. Payment Method
Card
ACH
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2. Payment Details

Convenience Fee (2.85%): $0

Total Amount: $0.00

Pay Now →
By clicking Pay Now, I agree to pay Allegra Winston Salem the above amount in accordance with the Card Issuer Agreement. I acknowledge the added Credit Card Convenience Fee of 2.85%. By clicking Pay Now, I agree to pay Allegra Winston Salem the above amount in accordance with the Card Issuer Agreement. I acknowledge the added Credit Card Convenience Fee of $2.85. By clicking Pay Now, I agree to pay Allegra Winston Salem the above amount in accordance with the Card Issuer Agreement.
3. Payment Confirmation

Invoice #[CustomInvoiceNumber] Paid

, Thank you for choosing Allegra Winston Salem! We appreciate your business.
Customer

Invoice #
AuthCode
Base Payment
$
Convenience Fee
$
Payment Amount
$
Card Number
xxxxxxxxx1234
Card Type
Card Number
Card Type

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