www.column.us
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Submitted URL: http://www.column.us/invoices/EZKwHT4szR04V3YnxTFS/pay
Effective URL: https://www.column.us/invoices/EZKwHT4szR04V3YnxTFS/pay
Submission: On September 07 via api from US — Scanned from US
Effective URL: https://www.column.us/invoices/EZKwHT4szR04V3YnxTFS/pay
Submission: On September 07 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
<form>
<div
style="box-sizing: border-box; border: 1px solid rgb(218, 218, 218); box-shadow: rgba(230, 235, 241, 0.25) 0px 1px 3px; border-radius: 4px; color: rgb(169, 183, 196); line-height: 19px; display: flex; flex-direction: column; align-items: center;">
<div style="width: 90%; height: 30px;">
<div style="margin-top: 6px;">
<div class="StripeElement StripeElement--empty">
<div class="__PrivateStripeElement" style="margin: 0px !important; padding: 0px !important; border: none !important; display: block !important; background: transparent !important; position: relative !important; opacity: 1 !important;">
<iframe name="__privateStripeFrame8893" frameborder="0" allowtransparency="true" scrolling="no" role="presentation" allow="payment *"
src="https://js.stripe.com/v3/elements-inner-card-4a9b5efed89e68a580a5ee1a8a44dfd1.html#wait=false&mids[guid]=NA&mids[muid]=NA&mids[sid]=NA&hidePostalCode=true&rtl=false&componentName=card&keyMode=live&apiKey=pk_live_rcQzdsMuxEALkEV9qiOcyLBi001yQrpvs5&referrer=https%3A%2F%2Fwww.column.us%2Finvoices%2FEZKwHT4szR04V3YnxTFS%2Fpay&controllerId=__privateStripeController8891"
title="Secure card payment input frame"
style="border: 0px !important; margin-top: 0.601562px; margin-right: 0px !important; margin-bottom: 0px !important; margin-left: 0px !important; padding: 0px !important; width: 1px !important; min-width: 100% !important; overflow: hidden !important; display: block !important; user-select: none !important; transform: translate(0px) !important; color-scheme: light only !important; height: 16.8px;"></iframe><input
class="__PrivateStripeElement-input" aria-hidden="true" aria-label=" " autocomplete="false" maxlength="1"
style="border: none !important; display: block !important; position: absolute !important; height: 1px !important; top: -1px !important; left: 0px !important; padding: 0px !important; margin: 0px !important; width: 100% !important; opacity: 0 !important; background: transparent !important; pointer-events: none !important; font-size: 16px !important;">
</div>
</div>
</div>
</div>
</div>
<div class="MuiBox-root jss317">
<div class="MuiBox-root jss320 jss318"><button class="MuiButtonBase-root MuiButton-root MuiButton-text jss319" tabindex="0" type="submit" id="pay-invoice-stripe"><span class="MuiButton-label">Pay invoice</span><span
class="MuiTouchRipple-root"></span></button></div>
</div>
</form>Text Content
You need to enable JavaScript to run this app. Invoice from Column Billed to Insurance - Statement of ConditionInvoice #231A9609-0001 past due -------------------------------------------------------------------------------- Pay invoice -------------------------------------------------------------------------------- Notice Name: 14184 - Acuity, A Mutual Ins Co DESCRIPTIONQTYPRICETOTAL08/14/2024: Insurance (Non-Life) Notice1$36.36$36.36*The cross-paper affidavit fee should be $0, and the $12 fee should be applied to all notice types except "government notice" (the aff fee for this notice type should be $0)1$0.00$36.36 PDF Subtotal $36.36 Tax(0%) $0.00 Processing Fee $3.64 Amount due $40.00 -------------------------------------------------------------------------------- If you have any questions, contact Column at help@column.us.