Make a Payment

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Notice: Element 74 recently updated this Authorization form.

Payment Information

Method Of Payment*

Invoice Number*

Invoice Amount*

Multiple Invoices

I have more than one invoice to pay

Recurring Transaction

This is a recurring payment

Would you like a paid invoice receipt?

I would like a receipt for this payment

When would you like to receive future invoices?*

Before Payment

After Payment

2nd Invoice Number*

2nd Invoice Amount*

Payer's Information

Your Name*

First Last

Company Name*

Payer's Email*

Address*

Street Address Address Line 2 City State ZIP Code

Card Information

Credit Card*

A 3% convenience fee applies to payments made by credit card, debit card, or Google Pay.

Total

Convenience Fee

$0.00

Total

Bank Account Information

Account Type*

Account Holder's Name*

Routing Number*

Confirm Routing Number*

Account Number*

Confirm Account Number*

Select a date to process the payment*

Payment Amount

ACH Processing Schedule

ACH information submitted through this form is entered manually into our electronic debit processing system and is not processed immediately upon receipt.

Completed ACH authorization forms must be received by 12:00 PM (Noon) Central Time on the business day prior to the requested batch date.

Forms received after the deadline will not be completed on the requested date.

Element 74, Inc
P.O Box 819, Cape Girardeau, MO 63702
Phone : 573 803 2675 | billing@element74.com