Card Payment Form

Credit/Debit Payment Form
Name
Name
First
Last
Ensure this matches the email of your Mobility Route billing profile.
Card Billing Address
Card Billing Address
Address Line 1
Address Line 2
City
State/Province
Zip/Postal

Except for the processing of deposits. Mobility Route does not support the alternative Credit/Debit card payment option for customers  based in or who's billing address is in the states of California, Colorado, Connecticut, Florida, Kanas, Maine, Massachusetts, New York, Oklahoma and Texas

Credit/Debit Card Authorization Terms

I, the above named individual, individually and on behalf of my associated company, hereby provide Mobility Route, Inc. ("Mobility Route") authorization to securely process this payment information via its payment processor ("Stripe") as my payment method for servicers provided by Mobility Route. A 3% processing fee of my invoice amount shall be applied to all payments where a one-time debit/credit card payment is requested and approved by Mobility Route. I understand this option is not available in the states outlined above, as well as select other states. I understand I may be required to still provide ACH payment information as an alternative payment.