IMPORTANT: Please fill out each section listed below. ALL sections are REQUIRED if you would like us to deliver your payment. Failure to completely fill out all required information may delay your payment's delivery. We reserve the right to refund your transaction, less a 2.9% transaction fee, if you do not completely fill out the forms and are unable to be contacted by phone or email within 48 hours of your payment submittal.
ALL INFORMATION REQUESTED ON THIS FORM IS FOR THE RESTORATION FEE CLIENT ONLY! IF YOU ARE MAKING THE PAYMENT ON THE BEHALF OF SOMEONE, PLEASE ENTER THEIR INFORMATION AND THE SYSTEM WILL PROMPT YOU WHEN YOUR INFORMATION IS NEEDED AT A LATER TIME. THANK YOU.