Website design, Web development, IT services, Melbourne, Sydney, Australia

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Exa Online Credit Card Payment Form

Welcome to Exa Online Credit Card Payment Facility. You may enter your organisation's invoice numbers, and amount for payment, along with your credit card details. This facility uses Exa Payment Service for secure, real-time, credit card payment service.

Please enter the invoice number(s) and total amount(s) you wish to pay in dollars and cents e.g. $123.00 - Please do not enter $123 otherwise your transaction will be processed as $1.23. If you wish to pay up front, but do not have an invoice number, please leave the Invoice Number blank and enter a brief description of the service you are paying for in the Further Details area. Also ensure you have entered the Amount field.

If you require any assistance with this Payment Service please contact Exa administration:

*Marked fields are compulsory fields

Payment Details

*	Invoice Number	:	(Example: EXA1234)
*	Total Payment : (in dollars & cents)	:	(Example: 100.99)
	Further Details (if applicable)	:

Client Details (your organisation's details)
*	Organisation Name	:
*	Address	:
	City	:
	State	:
	Post Code	:
	Country	:
	Contact Name	:
	Contact Phone	:
*	Contact Email	:
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