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
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 provide this payment information to its payment processor ("Stripe") as my payment method for any services. I understand that should any payments become past due or repeatedly fail, I may be required to switch to an ACH billing method, or another billing method as outlined in the Terms of Service. I hereby agree to switch to an ACH billing method by January 1st, 2023, or upon the failure of this payment card.

I also agree to a processing fee of 5% of my invoiced amounts for all payments made with this payment method, which may be accessed with the same or the next following invoice/charge.