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Submitted URL: https://secure.versapay.com/pay/1f403378-0ee4-49fd-abf5-d725b24be032
Effective URL: https://secure.versapay.com/payables/delineainc/pay/1f403378-0ee4-49fd-abf5-d725b24be032
Submission: On November 18 via manual from US — Scanned from DE
Effective URL: https://secure.versapay.com/payables/delineainc/pay/1f403378-0ee4-49fd-abf5-d725b24be032
Submission: On November 18 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /payables/delineainc/pay/1f403378-0ee4-49fd-abf5-d725b24be032
<form class="simple-validate" action="/payables/delineainc/pay/1f403378-0ee4-49fd-abf5-d725b24be032" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token"
value="pYosVBN-Sf2yIKwE6DeMsZ-HRNDKytX6KUOViK_bHdP9AcUJoAcnjlf9BU_WHfC8K76Wm-4FFO0huUUCmsGzmQ" autocomplete="off">
<div class="stack">
<div class="segment">
<div data-payable-data="{"count_by_fund_token":{},"accepted_fund_tokens":{},"violated_payment_rules":{}}" id="invoice_summary">
<div aria-level="4" class="summary_title" data-currency="usd" data-currency-symbol="$" data-invoice-summary-text-single="You are about to pay 1 invoice for [owing_cents]" data-invoices-count="1" role="heading">You are about to pay 1 invoice
for $43,972.72</div>
<div class="grid two-column-grid stackable" id="invoices-payment-form-section">
<div class="one_invoice_grid">
<div class="invoice_label"> Invoice # </div>
<div class="due_date_label"> Due Date </div>
<div class="amount_cents_label"> Amount </div>
<div class="owing_cents_label"> Balance </div>
<div class="number" title="INV-55504">
<a target="_blank" href="/payables/delineainc/pay/1f403378-0ee4-49fd-abf5-d725b24be032/invoice/1921382792">INV-55504</a>
</div>
<div class="due_date"> 2024-10-28 </div>
<div class="amount_cents money"> $43,972.72 </div>
<div class="owing_cents money"> $43,972.72 </div>
</div>
<div class="one_invoice_fee_box">
<div class="stack fees_box">
<div class="invoice-amount-details" data-credit-fee="3.0" data-currency="usd" data-currency-symbol="$" data-debit-fee="0.0" data-discount-amount="0" data-invoices-total="4397272">
<div class="horizontal-stack">
<div class="invoice-total-row fee-row hidden">
<div class="invoice_total_title"> Invoice Total </div>
<div class="invoices-total"> $43,972.72 </div>
</div>
</div>
<div class="horizontal-stack">
<div class="discount-row fee-row hidden">
<div class="discount_title"> Discounts </div>
<div class="discount-amount"></div>
</div>
</div>
<div class="horizontal-stack">
<div class="subtotal-row fee-row hidden">
<div class="subtotal_title"> Subtotal </div>
<div class="subtotal-amount"></div>
</div>
</div>
<div class="horizontal-stack">
<div class="debit-fee-row fee-row hidden">
<div class="fee_title"> Fee <span class="pay-fee-details">
<i class="material-icons info-icon icon fee-details-icon"></i>
</span>
</div>
<div class="debit-fee-amount"></div>
</div>
</div>
<div class="horizontal-stack">
<div class="credit-fee-row fee-row hidden">
<div class="surcharge_title"> Surcharge <span class="pay-fee-details">
<i class="material-icons info-icon icon fee-details-icon"></i>
</span>
</div>
<div class="credit-fee-amount"></div>
</div>
</div>
<div class="horizontal-stack">
<div class="total-row fee-row hidden">
<div class="total_title text-bold"> Total </div>
<div class="total-amount text-bold">$43,972.72</div>
</div>
</div>
<div class="horizontal-stack">
<div class="multi-currency-total-row fee-row hidden">
<div class="total_title text-bold"> Invoice Total USD </div>
<div class="total-amount text-bold">$43,972.72</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="segment">
<div class="stack" id="payment-information-section">
<h4 class="header"> Payment Information </h4>
<div class="alert warnings hidden" id="warning-messages-container">
<div class="amount-warning-section hidden">
<h5 class="header amount-warning-header"> We have adjusted your total amount </h5>
<ul>
<li class="warning-msg amount-warning discounts-not-available hidden"> Discounts are not available with this payment method. </li>
</ul>
</div>
<div class="list-warning-section hidden">
<h5 class="header list-warning-header" data-cannot-pay="Your payment cannot be processed." data-invoice-adjustment="We have adjusted your invoice list"> We have adjusted your invoice list </h5>
<ul>
<li class="warning-msg list-warning bank-cannot-pay-warning hidden"> USD bank accounts can only pay invoices in USD. </li>
<li class="warning-msg list-warning deleted-invoices hidden"> Cancelled invoices are no longer payable. </li>
<li class="warning-msg list-warning credit-invoices hidden"> Credits cannot be used on this page. Please contact Delinea Inc if you would like to use your credits </li>
<li class="warning-msg list-warning cc_fee_exempt_mismatch hidden"> Password must be added to make card payments for customers with different surcharge setups. </li>
<li class="warning-msg list-warning unavailable-invoice-warning hidden"> Invoices are not yet available from our system. </li>
<li class="warning-msg list-warning card-cannot-pay-warning hidden"> Cards can only pay invoices in USD </li>
<li class="warning-msg list-warning pending-invoices-warning hidden"> Invoices that require approval are not payable. </li>
<li class="warning-msg list-warning has-credits-warning hidden"> Some or all invoices can't be paid because they are summary invoices that include credits. </li>
<li class="warning-msg list-warning has-children-warning hidden"> Some or all invoices can't be paid because they are part of a summary invoice which must be paid in full. </li>
<li class="warning-msg list-warning invoice-has-pending-payments hidden"> One or more invoice(s) has a pending payment. </li>
<li class="warning-msg list-warning credit-card-payment-rule-warning hidden" data-allow-online="" data-days-accepted="-1" data-max-invoice-cents="-1" data-min-payment-cents="-1" data-payment-method="credit_card"> Payment Cards: Accepted
any time. </li>
<li class="warning-msg list-warning bank-account-payment-rule-warning hidden" data-allow-online="" data-days-accepted="-1" data-max-invoice-cents="-1" data-min-payment-cents="-1" data-payment-method="bank_account"> Bank Accounts:
Accepted any time. </li>
</ul>
</div>
</div>
<div class="grid two-column-grid credit-card" id="payment-form-section">
<div class="form-section" id="payment-method-section">
<div class="funding-src-section credit-card-section" data-address-form-key="credit_card"
data-discountable-cards="["master", "visa", "american_express", "discover", "master-debit", "visa-debit"]" data-payment-display-name="cards"
data-settlement-currencies="["usd"]">
<div class="acceptable-cards horizontal-stack" data-accepted-cards="["master", "visa", "american_express", "discover", "master-debit", "visa-debit"]"
data-credit-card-mapping="{"master":"MasterCard","visa":"Visa","american_express":"American Express","discover":"Discover"}">
<div class="small_credit_card_icon">
<div aria-label="master" class="master" role="img"></div>
</div>
<div class="small_credit_card_icon">
<div aria-label="visa" class="visa" role="img"></div>
</div>
<div class="small_credit_card_icon">
<div aria-label="american_express" class="american_express" role="img"></div>
</div>
<div class="small_credit_card_icon">
<div aria-label="discover" class="discover" role="img"></div>
</div>
<div class="small_credit_card_icon">
<div aria-label="master-debit" class="master-debit" role="img"></div>
</div>
<div class="small_credit_card_icon">
<div aria-label="visa-debit" class="visa-debit" role="img"></div>
</div>
</div>
<div class="form-section">
<h5 class="header"> Payment Card Information </h5>
<div class="field">
<label for="pay_credit_card_card_number">Card Number</label>
<div class="input-icon">
<div class="small_credit_card_icon" id="card-brand-container">
<div class="generic" id="card-brand" role="img" aria-label="generic"></div>
</div>
<input autocomplete="cc-number" type="text" name="pay[credit_card][card_number]" id="pay_credit_card_card_number">
</div>
</div>
<div class="field">
<label for="pay_credit_card_name">Cardholder Name</label>
<input autocomplete="cc-name" type="text" name="pay[credit_card][name]" id="pay_credit_card_name">
</div>
<div class="field-group" id="expiry-and-security-code">
<div class="field">
<label id="expiry_group_label" for="pay_credit_card_expiry_month">Expiration Date</label>
<div aria-labelledby="expiry_group_label" class="field-group" id="expiry" role="group">
<div class="field">
<div class="select2-container form-select" id="s2id_pay_credit_card_expiry_month">
<a href="javascript:void(0)" class="select2-choice" tabindex="-1"> <span class="select2-chosen" id="select2-chosen-1">MM</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow" role="presentation"><b role="presentation"></b></span></a><label
for="s2id_autogen1" class="select2-offscreen">Expiration Date</label><input class="select2-focusser select2-offscreen" type="text" aria-haspopup="true" role="button" aria-labelledby="s2id_autogen1 select2-chosen-1"
id="s2id_autogen1">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <label for="s2id_autogen1_search" class="select2-offscreen">Expiration Date</label> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false"
class="select2-input" role="combobox" aria-expanded="true" aria-autocomplete="list" aria-owns="select2-results-1" id="s2id_autogen1_search" placeholder=""> </div>
<ul class="select2-results" role="listbox" id="select2-results-1"> </ul>
</div>
</div><select class="form-select" name="pay[credit_card][expiry_month]" id="pay_credit_card_expiry_month" tabindex="-1" title="Expiration Date" style="display: none;">
<option value="">MM</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
</div>
<div class="field">
<div class="select2-container form-select" id="s2id_pay_credit_card_expiry_year">
<a href="javascript:void(0)" class="select2-choice" tabindex="-1"> <span class="select2-chosen" id="select2-chosen-2">YY</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow" role="presentation"><b role="presentation"></b></span></a><label
for="s2id_autogen2" class="select2-offscreen"></label><input class="select2-focusser select2-offscreen" type="text" aria-haspopup="true" role="button" aria-labelledby="s2id_autogen2 select2-chosen-2" id="s2id_autogen2">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <label for="s2id_autogen2_search" class="select2-offscreen"></label> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"
role="combobox" aria-expanded="true" aria-autocomplete="list" aria-owns="select2-results-2" id="s2id_autogen2_search" placeholder=""> </div>
<ul class="select2-results" role="listbox" id="select2-results-2"> </ul>
</div>
</div><select class="form-select" name="pay[credit_card][expiry_year]" id="pay_credit_card_expiry_year" tabindex="-1" title="" style="display: none;">
<option value="">YY</option>
<option value="2023">23</option>
<option value="2024">24</option>
<option value="2025">25</option>
<option value="2026">26</option>
<option value="2027">27</option>
<option value="2028">28</option>
<option value="2029">29</option>
<option value="2030">30</option>
<option value="2031">31</option>
<option value="2032">32</option>
<option value="2033">33</option>
<option value="2034">34</option>
<option value="2035">35</option>
<option value="2036">36</option>
</select>
</div>
</div>
</div>
<div class="field">
<label for="pay_credit_card_cvv">Security Code</label>
<input class="form-input" autocomplete="cc-csc" type="text" name="pay[credit_card][cvv]" id="pay_credit_card_cvv">
</div>
</div>
</div>
</div>
</div>
<div id="address-form-submit-section">
<div class="form-section"
data-config="{"subdivisions":{"CA":[{"id":"AB","text":"Alberta"},{"id":"BC","text":"British Columbia"},{"id":"MB","text":"Manitoba"},{"id":"NB","text":"New Brunswick"},{"id":"NL","text":"Newfoundland and Labrador"},{"id":"NT","text":"Northwest Territories"},{"id":"NS","text":"Nova Scotia"},{"id":"NU","text":"Nunavut"},{"id":"ON","text":"Ontario"},{"id":"PE","text":"Prince Edward Island"},{"id":"QC","text":"Quebec"},{"id":"SK","text":"Saskatchewan"},{"id":"YT","text":"Yukon"}],"US":[{"id":"AL","text":"Alabama"},{"id":"AK","text":"Alaska"},{"id":"AS","text":"American Samoa"},{"id":"AZ","text":"Arizona"},{"id":"AR","text":"Arkansas"},{"id":"AA","text":"Armed Forces Americas"},{"id":"AE","text":"Armed Forces Europe"},{"id":"AP","text":"Armed Forces Pacific"},{"id":"CA","text":"California"},{"id":"CO","text":"Colorado"},{"id":"CT","text":"Connecticut"},{"id":"DE","text":"Delaware"},{"id":"DC","text":"District of Columbia"},{"id":"FL","text":"Florida"},{"id":"GA","text":"Georgia"},{"id":"GU","text":"Guam"},{"id":"HI","text":"Hawaii"},{"id":"ID","text":"Idaho"},{"id":"IL","text":"Illinois"},{"id":"IN","text":"Indiana"},{"id":"IA","text":"Iowa"},{"id":"KS","text":"Kansas"},{"id":"KY","text":"Kentucky"},{"id":"LA","text":"Louisiana"},{"id":"ME","text":"Maine"},{"id":"MD","text":"Maryland"},{"id":"MA","text":"Massachusetts"},{"id":"MI","text":"Michigan"},{"id":"MN","text":"Minnesota"},{"id":"MS","text":"Mississippi"},{"id":"MO","text":"Missouri"},{"id":"MT","text":"Montana"},{"id":"NE","text":"Nebraska"},{"id":"NV","text":"Nevada"},{"id":"NH","text":"New Hampshire"},{"id":"NJ","text":"New Jersey"},{"id":"NM","text":"New Mexico"},{"id":"NY","text":"New York"},{"id":"NC","text":"North Carolina"},{"id":"ND","text":"North Dakota"},{"id":"MP","text":"Northern Mariana Islands"},{"id":"OH","text":"Ohio"},{"id":"OK","text":"Oklahoma"},{"id":"OR","text":"Oregon"},{"id":"PA","text":"Pennsylvania"},{"id":"PR","text":"Puerto Rico"},{"id":"RI","text":"Rhode Island"},{"id":"SC","text":"South Carolina"},{"id":"SD","text":"South Dakota"},{"id":"TN","text":"Tennessee"},{"id":"TX","text":"Texas"},{"id":"UM","text":"United States Minor Outlying Islands"},{"id":"UT","text":"Utah"},{"id":"VT","text":"Vermont"},{"id":"VI","text":"Virgin Islands, U.S."},{"id":"VA","text":"Virginia"},{"id":"WA","text":"Washington"},{"id":"WV","text":"West Virginia"},{"id":"WI","text":"Wisconsin"},{"id":"WY","text":"Wyoming"}],"AU":[{"id":"ACT","text":"Australian Capital Territory"},{"id":"NSW","text":"New South Wales"},{"id":"NT","text":"Northern Territory"},{"id":"QLD","text":"Queensland"},{"id":"SA","text":"South Australia"},{"id":"TAS","text":"Tasmania"},{"id":"VIC","text":"Victoria"},{"id":"WA","text":"Western Australia"}]},"bank_account_usd":{"header":"Bank Address","fields":{"pay_address_address_1":{"optional":true},"pay_address_address_2":{"optional":true},"pay_address_city":{"optional":true},"pay_address_country":{"locked":"US"},"pay_address_postal_code":{"optional":true}}},"credit_card":{"header":"Cardholder Address","fields":{"pay_address_address_2":{"optional":true}}}}"
id="address-section">
<h5 class="header">Cardholder Address</h5>
<div class="field">
<label for="pay_address_address_1">Address Line 1</label>
<input autocomplete="address-line1" type="text" name="pay[address][address_1]" id="pay_address_address_1">
</div>
<div class="field">
<label for="pay_address_address_2">Address Line 2</label>
<input class="optional" autocomplete="address-line2" type="text" name="pay[address][address_2]" id="pay_address_address_2">
</div>
<div class="field">
<label for="pay_address_city">City</label>
<input autocomplete="address-level2" type="text" name="pay[address][city]" id="pay_address_city">
</div>
<div class="field-group" id="address-details">
<div class="field">
<label for="pay_address_country">Country</label>
<div class="select2-container form-select no-divider pay-page" id="s2id_pay_address_country" title="Country" style="display: block;">
<a href="javascript:void(0)" class="select2-choice" tabindex="-1"> <span class="select2-chosen" id="select2-chosen-4">United States</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow" role="presentation"><b role="presentation"></b></span></a><label
for="s2id_autogen4" class="select2-offscreen">Country</label><input class="select2-focusser select2-offscreen" type="text" aria-haspopup="true" role="button" aria-labelledby="s2id_autogen4 select2-chosen-4" id="s2id_autogen4">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <label for="s2id_autogen4_search" class="select2-offscreen">Country</label> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"
role="combobox" aria-expanded="true" aria-autocomplete="list" aria-owns="select2-results-4" id="s2id_autogen4_search" placeholder=""> </div>
<ul class="select2-results" role="listbox" id="select2-results-4"> </ul>
</div>
</div><select class="form-select select2-disable-auto-width no-divider" autocomplete="new-password" name="pay[address][country]" id="pay_address_country" title="Country" style="display: none;" tabindex="-1">
<option value="" label=" "></option>
<option value="CA">Canada</option>
<option selected="selected" value="US">United States</option>
<option value="AU">Australia</option>
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia, Plurinational State of</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, The Democratic Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia, Republic of</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine, State of</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SS">South Sudan</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian Republic of</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
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<div class="field">
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<a href="javascript:void(0)" class="select2-choice" tabindex="-1"> <span class="select2-chosen" id="select2-chosen-6"> </span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow" role="presentation"><b role="presentation"></b></span></a><label
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<div class="select2-drop select2-display-none select2-with-searchbox">
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class="select2-input" role="combobox" aria-expanded="true" aria-autocomplete="list" aria-owns="select2-results-6" id="s2id_autogen6_search" placeholder=""> </div>
<ul class="select2-results" role="listbox" id="select2-results-6"> </ul>
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</div><input type="text" name="pay[address][province]" id="pay_address_province" class="no-divider" title="State/Province" style="display: none;" tabindex="-1">
</div>
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<label for="pay_address_postal_code">Zip/Postal</label>
<input autocomplete="postal-code" type="text" name="pay[address][postal_code]" id="pay_address_postal_code">
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<button name="button" type="submit" class="standard_button disabled" id="submit-payment" disabled=""
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You are about to pay 1 invoice for $43,972.72
Invoice #
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Amount
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INV-55504
2024-10-28
$43,972.72
$43,972.72
Invoice Total
$43,972.72
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$43,972.72
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