Enter New Bill Data

Enter New Bill Information

Please enter the following information for your new bill.

Section 1 : Bill Reference Information

Please enter the following information only if you are using this account for your business

Bill #		Your Reference #
Bill Date		Bill Due Date	(00 / 00 / 00)

Section 2 : Payment Recipient Information (Payee)

The following will be automatically entered if you are a Payee. Otherwise, please enter the following.

Section 3 : Payment Maker Information (Payer)

The following will be automatically entered if you are a Payer. Otherwise, please enter the following.

Company Name*		Enter only if this purchase is for a company.
Your Company Title*

User ID*		Enter this if you know it. This will make updating your account much faster.
Courtesy Title
First Name*, Initial	,
Last Name*
Address*

City*
State or Province*		US Residents please enter the two letter abbreviation for your state (ie. CA)
Zip/Postal Code*
Country*
	Ship To Address If Different Than Above :
Address*

City*
State or Province*		US Residents please enter the two letter abbreviation for your state (ie. CA)
Zip/Postal Code*
Country*

E-Mail Address*
Phone Number*		(555-555-5555)
Fax Number		(555-555-5555)
Miscellaneous		Description
Miscellaneous		Description

Section 4 : Item Information

The following will be automatically entered if you are a Payer. Otherwise, please enter the following.

Item List

Account

($ will be deposited to this account)

Payment Forms

In which forms will you accept payments for this bill :

Checking Account

Mastercard

VISA

American Express

Diner's Club

Discover

By Mail:

Personal Check

Co. Check

Money Order

Certified Check

Shipping & Handling

Tax %

Misc. Fee

for (description)

Misc. Fee

for (description)

Shipping Options

Cost