payment.jmbm.com Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST /

<form method="post" action="/">
  <input type="hidden" name="stage" value="1">
  <fieldset>
    <label>
      <strong>Client Name <sup class="rrequired">*</sup></strong>
      <span>
        <input type="text" name="x_ship_to_first_name" value="" maxlength="50" required="">
      </span>
    </label>
    <label>
      <strong>Client Matter # <sup class="rrequired">*</sup></strong>
      <span>
        <input type="text" name="x_cust_id" value="" maxlength="17" required="">
        <span class="form-instructions">If new client, write "New."</span>
      </span>
    </label>
    <label>
      <strong>Email <sup class="rrequired">*</sup></strong>
      <span>
        <input type="text" name="x_email" value="" maxlength="255" required="">
      </span>
    </label>
    <label>
      <strong>Phone</strong>
      <span>
        <input type="tel" name="x_phone" value="" maxlength="24">
      </span>
    </label>
    <label>
      <strong>Amount $ <sup class="rrequired">*</sup></strong>
      <span>
        <input pattern="[0-9]*" type="number" min="1.00" step="0.01" name="x_amount" value="" maxlength="20" required="">
        <span class="form-instructions">Do not use commas.</span>
      </span>
    </label>
    <label>
      <strong>Invoice # <sup class="rrequired">*</sup></strong>
      <span>
        <input type="text" name="x_invoice_num" value="" maxlength="20" required="">
        <span class="form-instructions">If no invoice, write "Retainer."</span>
      </span>
    </label>
    <label>
      <strong>Special Instructions</strong>
      <span>
        <input type="text" name="x_description" value="">
        <span class="form-instructions">If new client, write the name of your attorney.</span>
      </span>
    </label>
    <span class="disclaimer-box">
      <input type="checkbox" name="x_disclaimer" required="">I have read JMBM's Bill Pay and Privacy policies. </span>
  </fieldset>
  <span class="submitbtn">
    <input name="submit" type="submit" id="Submit" value="Next">
  </span>
</form>

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JMBM PAYMENT

Welcome to JMBM's online payment portal. After completing this form and clicking
"Next", you will be taken to a secure, encrypted Web page for submitting your
credit card or banking information.

Client Name * Client Matter # * If new client, write "New." Email * Phone Amount
$ * Do not use commas. Invoice # * If no invoice, write "Retainer." Special
Instructions If new client, write the name of your attorney. I have read JMBM's
Bill Pay and Privacy policies.

Click to review JMBM's Bill Pay Policy

Click to review JMBM’s Privacy Policy

SUBSCRIBE
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Questions?

Contact Robert Martinez
Accounts Receivable Department

Jeffer Mangels Butler & Mitchell LLP
1900 Avenue of the Stars, 7th Floor
Los Angeles, CA 90067

Phone: 310.785.5355
Email: RMartinez@jmbm.com

 
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