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Hill Valley Simple Payment Item - Inspection

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This is the simple payment item to collect a fee for Inspections.

To make your payment you would have to have your Invoice Number and Customer Number.

* Denotes a required field

Customer Name*

Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

Email Address*

Confirm Email Address*

Invoice Number*

Please Do Not Complete The Following Field

Customer Number*

Comments

Payment Amount*