Billing – Babylon Leads

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Payment Submission Form

Billing Info

Owner Nameyour full name

Business Nameyour full name

Email For Your Receipta valid email

Phone Number

Payment Method

ACH Online CheckCredit Card

Credit Card #

Expiration Date (MM/YY)

CCV Code

Billing Address

City, State, Zip Code

Corporation or Business Nameyour full name

Routing Number

Account Number

* By submitting this form, you agree and authorize us to withdraw money based on your account's balance and according to the terms and conditions of your service *