Acceptiva Via Mobile Payment App

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

For use with the Acceptiva Via Mobile Payments App
5-10 Card Readers

Qty

Description

Amount

Total

Mobile Device Card Reader(s)For iPhone 4S or newer, iPad 4, iPad Pro, iPad mini and select Android Devices.

$79.00

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CLICK HERE to view a list of supported Android mobile devices. If your device is NOT on this list it will NOT work with the Acceptiva Via Mobile App.

Domestic Shipping via USPS Priority Mail (2-3 days)

$17.90

All product is shipped with delivery confirmation.

Total: $17.90

Acceptiva Client Organization Name: *

Please enter the name of your organization above.

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Shipping Address is the Same as Above:

Check this box if the shipping address for this order is the same as the Payer Information entered above.

Shipping Address - (ONLY if different from above)

Name:

Shipping Address:

Address 2:

City:

State:

Zip Code:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *