billpaydev.forestlawn.com
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URL:
https://billpaydev.forestlawn.com/
Submission: On November 08 via api from US — Scanned from DE
Submission: On November 08 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form class="space-y-4 p-4 bg-[#FFFFF0]">
<div class="md:w-[60%] mx-auto bg-[#E0e9C6] pt-[20px] pb-[30px] px-[20px] ">
<h2 class=" text-[24px] md:text-[36px] text-[#626D4D]">Card Holder Information</h2>
<p class="text-red-600 italic py-[20px]">All fields are required</p>
<p class="italic text-[14px]">Enter the card holder name as it appears on the front of the credit card.</p>
<div class="flex gap-8 pt-[16px] items-center"><label class="block text-sm md:text-base md:w-[20%] text-[#626D4D]">First Name</label>
<div class="w-[65%]"><input class="mt-1 block w-full " style="border:1px solid black" name="firstName"></div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block text-sm md:w-[20%] text-[#626D4D]">Last Name</label>
<div class="w-[65%]"><input class="mt-1 block w-full " style="border:1px solid black" name="lastName"></div>
</div>
<div class="py-[50px]">
<p class="text-red-500 font-bold">For account verification, enter the address where you receive the bill for this credit card.</p>
</div>
<div class="flex gap-8 items-center"><label class="block text-sm md:text-base w-[20%] text-[#626D4D]">Street Address</label>
<div class="w-[65%]"><input class="mt-1 block w-full " style="border:1px solid black" name="streetAddress"></div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block w-[20%] text-sm md:text-base text-[#626D4D]">City</label>
<div class="w-[65%]"><input class="mt-1 block w-full " style="border:1px solid black" name="city"></div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block w-[20%] text-sm md:text-base text-[#626D4D]">State</label>
<div class="w-[65%]"><select name="state" class="mt-1 block md:w-[20%] py-[5px] " style="border:1px solid black">
<option value="">Select a state</option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
</select></div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block w-[20%] text-sm md:text-base text-[#626D4D]">Zip</label>
<div class="w-[65%]"><input class="mt-1 block w-full " style="border:1px solid black" name="zip"></div>
</div>
<div class="pt-[16px]">
<p class="italic text-[14px]">This information will be used if there is a question about your payment and to send receipt confirmation. We do not sell contact information to third parties.</p>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block w-[20%] text-sm md:text-base text-[#626D4D]">Phone</label>
<div class="w-[65%]"><input placeholder="111-555-5555" class="mt-1 block w-full " style="border:1px solid black" name="phone"></div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block w-[20%] text-sm md:text-base text-[#626D4D]">Email Address</label>
<div class="w-[65%]"><input class="mt-1 block w-full " style="border:1px solid black" name="email"></div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block w-[20%] text-sm md:text-base text-[#626D4D]">Confirm Email Address</label>
<div class="w-[65%]"><input class="mt-1 block w-full " style="border:1px solid black" name="confirmEmail"></div>
</div>
</div>
<div class="md:w-[60%] mx-auto bg-[#E0e9C6] py-[30px] px-[20px] ">
<h2 class="text-[24px] md:text-[36px] text-[#626D4D]">Credit Card Information</h2>
<p class="text-red-600 italic py-[20px]">All fields are required</p>
<p class="italic text-[14px]">We accept Visa, MasterCard, and Discover.</p>
<div class="flex gap-8 pt-[16px] items-center"><label class="block text-sm md:text-base w-[29%] md:w-[20%] text-[#626D4D]">Card Type</label>
<div class="md:w-[25%]"><select name="cardType" class="mt-1 block w-full py-[4px] " style="border:1px solid black">
<option value="">Select Card Type</option>
<option value="Visa">Visa</option>
<option value="MasterCard">MasterCard</option>
<option value="Discover">Discover</option>
</select></div>
</div>
<div class="flex gap-8 pt-[16px] items-start md:items-center"><label class="block w-[30%] md:w-[20%] text-sm md:text-base text-[#626D4D]">Card Number</label>
<div class="w-[65%] flex flex-col md:flex-row items-end md:items-center gap-2">
<div class="md:w-[38%] flex gap-4"><input type="number" class="mt-1 block w-full" style="border:1px solid black" name="cardNumber"></div>
<p class="italic text-[12px] md:text-[14px] "> <!-- -->No space or dashes</p>
</div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block text-sm md:text-base w-[30%] md:w-[20%] text-[#626D4D]">Expiration Date</label>
<div class="w-[65%] flex items-center gap-2"><input placeholder="mm/yyyy" class="block w-[50%] md:w-[38%] " style="border:1px solid black" name="expirationDate">
<p class="italic text-xs md:text-[14px] flex item-center gap-2"><svg stroke="currentColor" fill="currentColor" stroke-width="0" viewBox="0 0 448 512" height="1em" width="1em" xmlns="http://www.w3.org/2000/svg">
<path
d="M152 24c0-13.3-10.7-24-24-24s-24 10.7-24 24V64H64C28.7 64 0 92.7 0 128v16 48V448c0 35.3 28.7 64 64 64H384c35.3 0 64-28.7 64-64V192 144 128c0-35.3-28.7-64-64-64H344V24c0-13.3-10.7-24-24-24s-24 10.7-24 24V64H152V24zM48 192h80v56H48V192zm0 104h80v64H48V296zm128 0h96v64H176V296zm144 0h80v64H320V296zm80-48H320V192h80v56zm0 160v40c0 8.8-7.2 16-16 16H320V408h80zm-128 0v56H176V408h96zm-144 0v56H64c-8.8 0-16-7.2-16-16V408h80zM272 248H176V192h96v56z">
</path>
</svg>mm/yyyy</p>
</div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block md:w-[20%] text-sm md:text-base text-[#626D4D]">Security Code</label>
<div class="w-[65%] flex items-center gap-2"><input class="mt-1 block w-[4rem] md:w-[20%] " style="border:1px solid black" name="securityCode">
<p class="italic text-xs md:text-[14px] flex item-center gap-2">Enter the 3 digit security code on the back of the card.</p>
</div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block w-[30%] text-sm md:text-base md:w-[20%] text-[#626D4D]">Payment Amount</label>
<div class="w-[65%] flex items-center gap-2"><input type="number" class="mt-1 block w-[38%] " style="border:1px solid black" name="paymentAmount">
<p class="italic text-[12px] md:text-[14px] flex item-center gap-2">US Dollars only</p>
</div>
</div>
<p class="italic text-xs md:text-[14px] pb-[16px] pt-[24px]">Any credit card information entered is not retained and will be erased after your payment has processed.</p>
</div>
<div class="md:w-[60%] mx-auto bg-[#E0e9C6] py-[30px] px-[20px] ">
<h2 class="text-[24px] md:text-[36px] text-[#626D4D]">Purchaser Information</h2>
<p class="text-red-600 italic py-[20px]">All fields are required</p>
<div class="flex gap-8 pt-[16px] items-center"><label class="block text-sm md:text-base w-[30%] md:w-[20%] text-[#626D4D]">Account #</label>
<div class="w-[65%]"><input class="mt-1 block w-full border border-gray-300 " style="border:1px solid black" name="accountNumber"></div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block text-sm md:text-base w-[30%] md:w-[20%] text-[#626D4D]">Re-enter Account #</label>
<div class="w-[65%]"><input class="mt-1 block w-full border border-gray-300 " style="border:1px solid black" name="reEnterAccountNumber"></div>
</div>
<div class="flex gap-8 pt-[16px] items-center"><label class="block w-[30%] text-sm md:text-base md:w-[20%] text-[#626D4D]">Name on Contract</label>
<div class="w-[65%]"><input class="mt-1 block w-full border border-gray-300 " style="border:1px solid black" name="nameOnContract"></div>
</div><button type="submit" style="text-shadow:1px 1px 0px rgba(0, 0, 0, 0.5)" class="mt-8 bg-[#97751E] text-sm md:text-base text-white py-2 px-4 rounded">Review Payment Method</button>
<div class="md:w-[80%] mt-[20px] mx-auto border-y-[1.5px] border-solid border-[#8D8866] py-[20px]">
<p class="text-[#626D4D] text-[11px] text-center">Thank you for your interest in Forest Lawn.</p>
<div class="gap-8 flex flex-col md:flex-row pt-[10px]">
<p class="text-[#626D4D] text-[12px]">Copyright @ 2024 FOREST LAWN MEMORIAL-PARK ASSOCATION FOREST LAWN MEMORIAL-PARKS & MORTUARIES</p>
<div class="flex ">
<p class="text-[#626D4D] text-[11px] ">We respect your privacy and will not sell your personal information. Forest Lawn will collect and use the information you provide here to periodically email, call or text you with information about
products, services, and events according to the terms of the Forest Lawn<!-- --> <a class="underline" href="">Privacy Policy and Terms of Use</a> <!-- -->, until you change your communication preferences
at<a class="underline" href="">www.forestlawn.com/preferences.</a></p>
</div>
</div>
</div>
<div class="pt-[16px] flex flex-col gap-2">
<p class="text-[#626D4D] text-center text-[11px] font-light">ARCADIA FD 2186 | CATHEDRAL CITY FD 1847 | CITY OF INDUSTRY FD 2121 | COACHELLA FD 640 | COVINA HILLS FD 1150 | CYPRESS FD 1051</p>
<p class="text-[#626D4D] text-center text-[11px] font-light">GLENDALE FD 656 | HOLLYWOOD HILLS FD 904 | INDIO FD 967 | LONG BEACH FD 1151 | MONROVIA FD 221 | SAN DIMAS FD 1783 | WHITTIER FD 2302</p>
</div>
</div>
</form>Text Content
Thank you for choosing Forest Lawn's online bill payment option. You can make
your monthly payment instantly with no user name or passwords to remember. All
you need is your information and a credit card.
PLEASE NOTE: You will need your full account information, including your Account
Number. The Account Number can be found on your monthly statement.
Once you have your Account Number, simply enter the required information below
and click SUBMIT. Our Bill Pay system will update your account within two (2)
business days of your approved credit card payment. For your convenience, we
accept the following methods of payment: Visa, MasterCard and Discover.
This Bill Pay feature only applies to advance planning accounts ("ahead of need"
plans). Accounts that are considered at-need ("time of loss" plans) cannot use
this feature at this time. To pay for "at-need" plans, please call the park's
cashier at the number provided by your Memorial Counselor.
If you have any questions, please call 1 (888) 204-3131 and ask for Client
Accounts. We have staff available to assist you Monday through Friday, 8:00 am
to 5:00 pm.
Call Us Directly
(888) 204-3131
Thank you again for choosing the quickest and easiest way to make a payment with
Forest Lawn.
CARD HOLDER INFORMATION
All fields are required
Enter the card holder name as it appears on the front of the credit card.
First Name
Last Name
For account verification, enter the address where you receive the bill for this
credit card.
Street Address
City
State
Select a
stateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Zip
This information will be used if there is a question about your payment and to
send receipt confirmation. We do not sell contact information to third parties.
Phone
Email Address
Confirm Email Address
CREDIT CARD INFORMATION
All fields are required
We accept Visa, MasterCard, and Discover.
Card Type
Select Card TypeVisaMasterCardDiscover
Card Number
No space or dashes
Expiration Date
mm/yyyy
Security Code
Enter the 3 digit security code on the back of the card.
Payment Amount
US Dollars only
Any credit card information entered is not retained and will be erased after
your payment has processed.
PURCHASER INFORMATION
All fields are required
Account #
Re-enter Account #
Name on Contract
Review Payment Method
Thank you for your interest in Forest Lawn.
Copyright @ 2024 FOREST LAWN MEMORIAL-PARK ASSOCATION FOREST LAWN MEMORIAL-PARKS
& MORTUARIES
We respect your privacy and will not sell your personal information. Forest Lawn
will collect and use the information you provide here to periodically email,
call or text you with information about products, services, and events according
to the terms of the Forest Lawn Privacy Policy and Terms of Use , until you
change your communication preferences atwww.forestlawn.com/preferences.
ARCADIA FD 2186 | CATHEDRAL CITY FD 1847 | CITY OF INDUSTRY FD 2121 | COACHELLA
FD 640 | COVINA HILLS FD 1150 | CYPRESS FD 1051
GLENDALE FD 656 | HOLLYWOOD HILLS FD 904 | INDIO FD 967 | LONG BEACH FD 1151 |
MONROVIA FD 221 | SAN DIMAS FD 1783 | WHITTIER FD 2302