Service Agreement

SECURE CREDIT CARD PAYMENT VAULT

Use the form below to securely provide your credit card information for payment. Upon form submission, this page will display a customer ID number for your records. Please note that when you vault your credit card this way, you grant ClickSafety permission to charge your credit card for the full amount of your invoice.

CREDIT CARD INFORMATION

Company Name

Company Name is a required field

First Name

First Name is a required field

Last Name

Last Name is a required field

Phone Number

Please, enter a valid Phone Number

Email Address

Please, enter a valid Email Address

Card number

Please, enter a valid Card Number

CVV

Please, enter valid Security Code

Expiration Date

Please, enter valid Expiration Date

Postal Code

Please, enter valid Postal Code