Special Payment Form

Your Image

Please use this special payment form as instructed by Team Fortin.

IMPORTANT:

Please use the same email you used to make your original payment, so the payment is applied to the correct account.

Contact Information

Normally: [[customer_pricing.currency]][[customer_pricing.suggested_price]]

Payment Methods

[[cardNumberError]]
[[cardExpiryError]]
[[cardCvcError]]
[[postalCodeError]]
Subtotal:
[[checkoutContext.order.invoice.subtotal | currency]]
Tax:
[[checkoutContext.order.invoice.tax | currency]]
Shipping:
[[checkoutContext.order.invoice.shipping | currency]]
Discounts:
-[[checkoutContext.order.invoice.discount | currency]]
Total:
[[checkoutContext.order.invoice.total | currency]] (USD)
[[subscriptionsByProductId[checkoutContext.order.invoice.items[0].product_id].plan_description]]