One Time Payment PowerPay

All * marked fields are mandatory. Please make sure you have filled in the correct information including your address and zip code.

Select Payment Method
Charge a Credit Card Charge a Bank Account
Payment/Authorization Information
Original Transaction ID	(not required for unlinked refunds)*
ABA Routing Number	*
Account Number	*
Bank Name	*
Name on Bank Account	*
Bank Account Type	*
eCheck Type	*
Accepted Payment Method	American Express, Discover, eCheck, MasterCard, Visa
Card Number	(enter number without spaces)*
Expiration Date	(mmyy)*
Amount	(i.e.,10.00)*
Card Code	*
TIPS FOR SUBMITTING REFUNDS: + A refund may only be issued for a charge transaction settled within the past 120 days. + The full Credit Card number isrouting and account number are only required for unlinked refunds (without spaces). + Be sure to enter the correct amount for a partial refund.
Customer Billing Information
First Name	*
Last Name	*
Company	( optional )
Address	( optional )
City	( optional )
State/Province	( optional )
Zip Code	( optional )
Email	*
Security Code:	*

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