Make a Payment 1 Payment Information2 Payment Schedule3 Make Payment Advertiser Name / Corporate Name*Account NumberIf you have an account number, please enter here.Invoice NumberShould an invoice number not be supplied the payment will be applied to the oldest open invoice for your account.Additional Invoice Numbers, if necessaryIf you are paying more than one invoice, please add the additional ones here. Simply click the plus button to add another field. Credit Card TypeCredit CardCorporate CardName on the Credit Card* First Last Company Name on Credit Card*Billing Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact NameIf your name is different than the card holder's name, please enter your name here. First Last Email* Phone*Payment Options*One Time PaymentMonthly ReoccurringReoccuring Payment Duration*Please enter the quantity of months in your agreement that you are scheduling for payment.123456789101112Start Date* Amount*The amount due each period can be found in paragraph 3.A. of the Outdoor Advertising Sales Agreement Payment Dates*Below is your payment schedule with JGI for the term of your agreement. Should you need to adjust any individual payments for any reason, you are able to adjust them in the date pickers below. Please note the payments can only be moved within 7 days of the original date.Payment 1 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.