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Submitted URL: http://www.demottechamber.org/payinvoice
Effective URL: http://demottechamber.org/payinvoice/
Submission: On January 23 via manual from US — Scanned from DE
Effective URL: http://demottechamber.org/payinvoice/
Submission: On January 23 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /payinvoice/
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class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript>
<div class="wpforms-field-container">
<div id="wpforms-3524-field_23-container" class="wpforms-field wpforms-field-divider" data-field-id="23">
<h3 id="wpforms-3524-field_23" name="wpforms[fields][23]">Invoice Information</h3>
</div>
<div id="wpforms-3524-field_24-container" class="wpforms-field wpforms-field-text" data-field-id="24"><label class="wpforms-field-label" for="wpforms-3524-field_24">Business Name * <span class="wpforms-required-label">*</span></label><input
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<div id="wpforms-3524-field_25-container" class="wpforms-field wpforms-field-text" data-field-id="25"><label class="wpforms-field-label" for="wpforms-3524-field_25">Invoice Number * <span class="wpforms-required-label">*</span></label><input
type="text" id="wpforms-3524-field_25" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][25]" required=""></div>
<div id="wpforms-3524-field_27-container" class="wpforms-field wpforms-field-text" data-field-id="27"><label class="wpforms-field-label" for="wpforms-3524-field_27">Invoice Description <span class="wpforms-required-label">*</span></label><input
type="text" id="wpforms-3524-field_27" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][27]" required=""></div>
<div id="wpforms-3524-field_26-container" class="wpforms-field wpforms-field-payment-single" data-field-id="26"><label class="wpforms-field-label" for="wpforms-3524-field_26">Invoice Amount * <span
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<div id="wpforms-3524-field_21-container" class="wpforms-field wpforms-field-divider" data-field-id="21">
<h3 id="wpforms-3524-field_21" name="wpforms[fields][21]">Card Holder Information</h3>
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<div id="wpforms-3524-field_1-container" class="wpforms-field wpforms-field-name" data-field-id="1"><label class="wpforms-field-label" for="wpforms-3524-field_1">Credit card holder name <span class="wpforms-required-label">*</span></label>
<div class="wpforms-field-row wpforms-field-medium">
<div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-3524-field_1" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][1][first]" required=""><label
for="wpforms-3524-field_1" class="wpforms-field-sublabel after ">First</label></div>
<div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-3524-field_1-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][1][last]" required=""><label for="wpforms-3524-field_1-last"
class="wpforms-field-sublabel after ">Last</label></div>
</div>
</div>
<div id="wpforms-3524-field_4-container" class="wpforms-field wpforms-field-address" data-field-id="4"><label class="wpforms-field-label" for="wpforms-3524-field_4">Credit card holder address <span class="wpforms-required-label">*</span></label>
<div class="wpforms-field-row wpforms-field-medium">
<div><input type="text" id="wpforms-3524-field_4" class="wpforms-field-address-address1 wpforms-field-required" name="wpforms[fields][4][address1]" required=""><label for="wpforms-3524-field_4"
class="wpforms-field-sublabel after wpforms-sublabel-hide">Address Line 1</label></div>
</div>
<div class="wpforms-field-row wpforms-field-medium">
<div class="wpforms-field-row-block wpforms-one-half wpforms-first"><input type="text" id="wpforms-3524-field_4-city" class="wpforms-field-address-city wpforms-field-required" name="wpforms[fields][4][city]" required=""><label
for="wpforms-3524-field_4-city" class="wpforms-field-sublabel after wpforms-sublabel-hide">City</label></div>
<div class="wpforms-field-row-block wpforms-one-half"><select id="wpforms-3524-field_4-state" class="wpforms-field-address-state wpforms-field-required" name="wpforms[fields][4][state]" required="">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
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<option value="CA">California</option>
<option value="CO">Colorado</option>
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<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select><label for="wpforms-3524-field_4-state" class="wpforms-field-sublabel after wpforms-sublabel-hide">State</label></div>
</div>
<div class="wpforms-field-row wpforms-field-medium">
<div class="wpforms-field-row-block wpforms-one-half wpforms-first"><input type="text" id="wpforms-3524-field_4-postal" class="wpforms-field-address-postal wpforms-field-required wpforms-masked-input"
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class="wpforms-field-sublabel after wpforms-sublabel-hide">Zip Code</label></div>
</div>
</div>
<div id="wpforms-3524-field_3-container" class="wpforms-field wpforms-field-phone" data-field-id="3"><label class="wpforms-field-label" for="wpforms-3524-field_3">Phone <span class="wpforms-required-label">*</span></label><input type="tel"
id="wpforms-3524-field_3" class="wpforms-field-medium wpforms-field-required wpforms-masked-input" data-inputmask="'mask': '(999) 999-9999'" data-rule-us-phone-field="true" data-inputmask-inputmode="tel" name="wpforms[fields][3]" required=""
inputmode="tel"></div>
<div id="wpforms-3524-field_2-container" class="wpforms-field wpforms-field-email" data-field-id="2"><label class="wpforms-field-label" for="wpforms-3524-field_2">Email <span class="wpforms-required-label">*</span></label>
<div class="wpforms-field-row wpforms-field-medium">
<div class="wpforms-field-row-block wpforms-one-half wpforms-first"><input type="email" id="wpforms-3524-field_2" class="wpforms-field-required wpforms-field-email-primary" name="wpforms[fields][2][primary]" required=""><label
for="wpforms-3524-field_2" class="wpforms-field-sublabel after ">Email</label></div>
<div class="wpforms-field-row-block wpforms-one-half"><input type="email" id="wpforms-3524-field_2-secondary" class="wpforms-field-email-secondary wpforms-field-required" data-rule-confirm="#wpforms-3524-field_2"
name="wpforms[fields][2][secondary]" required=""><label for="wpforms-3524-field_2-secondary" class="wpforms-field-sublabel after ">Confirm Email</label></div>
</div>
</div>
<div id="wpforms-3524-field_17-container" class="wpforms-field wpforms-field-divider" data-field-id="17">
<h3 id="wpforms-3524-field_17" name="wpforms[fields][17]">Credit Card Information</h3>
</div>
<div id="wpforms-3524-field_11-container" class="wpforms-field wpforms-field-square" data-field-id="11"><label class="wpforms-field-label wpforms-label-hide" for="wpforms-3524-field_11">Square <span class="wpforms-required-label">*</span></label>
<div class="wpforms-cc-warning wpforms-error-alert">This page is insecure. Credit Card field should be used for testing purposes only.</div>
<div class="wpforms-field-row wpforms-field-medium">
<div class="wpforms-field-square-number">
<div id="wpforms-3524-field_11" class="wpforms-field-square-cardnumber wpforms-field-required" data-required="required"><!-- Square credit card will be inserted here. --></div><input type="text"
class="wpforms-square-credit-card-hidden-input" name="wpforms[square-credit-card-hidden-input-3524]" id="wpforms-square-credit-card-hidden-input-3524" disabled="" style="display: none;"><label class="wpforms-error">Web Payments SDK can
only be embedded on sites that use HTTPS</label><label for="wpforms-3524-field_11" class="wpforms-field-sublabel after ">Card</label>
</div>
</div>
<div class="wpforms-field-row wpforms-field-medium">
<div class="wpforms-field-square-name"><input type="text" id="wpforms-3524-field_11-cardname" class="wpforms-field-square-cardname wpforms-field-required" name="wpforms[fields][11][cardname]" required=""><label
for="wpforms-3524-field_11-cardname" class="wpforms-field-sublabel after ">Name on Card</label></div>
</div>
</div>
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<div class="wpforms-submit-container"><input type="hidden" name="wpforms[id]" value="3524"><input type="hidden" name="wpforms[author]" value="2"><input type="hidden" name="wpforms[post_id]" value="3515"><button type="submit" name="wpforms[submit]"
id="wpforms-submit-3524" class="wpforms-submit" data-alt-text="Sending..." data-submit-text="Submit" aria-live="assertive" value="wpforms-submit">Submit</button><img
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</form>Text Content
* Facebook * Mail 327 N. Halleck St., DeMotte, IN 46310 (219) 987-5800 * Home * Chamber * Join the Chamber * About Us * Our Leadership * Award Recipients * Calendar * Scholarship * Photo Gallery * Get Local Videos * Member Directory * Touch of Dutch * Contact Us * Subscribe to our e-mails * Pay Invoice * Menu Menu PAY INVOICE You are here: Home1 / Pay Invoice PAY INVOICE (*) Denotes Required Fields This is a safe and secure way to pay any invoices you have for the DeMotte Chamber of Commerce. The Chamber does not retain any credit card information during this transaction. Please enter your business name, invoice number, and amount you wish to pay. If you need assistance or have problems using this form, call the Chamber office at 219-987-5800. Please enable JavaScript in your browser to complete this form. INVOICE INFORMATION Business Name * * Invoice Number * * Invoice Description * Invoice Amount * * CARD HOLDER INFORMATION Credit card holder name * First Last Credit card holder address * Address Line 1 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState Zip Code Phone * Email * Email Confirm Email CREDIT CARD INFORMATION Square * This page is insecure. Credit Card field should be used for testing purposes only. Web Payments SDK can only be embedded on sites that use HTTPSCard Name on Card Comment or Message (optional) Submit UPCOMING EVENT 03 February 2023 CHAMBER BOARD MEETING DeMotte Chamber Office, 327 N. Halleck St., Demotte, Indiana * * * * * * View Detail 03 February 2023 CHAMBER BOARD MEETING DeMotte Chamber Office, 327 N. Halleck St., Demotte, Indiana * * * * * * View Detail 03 February 2023 CHAMBER BOARD MEETING DeMotte Chamber Office, 327 N. Halleck St., Demotte, Indiana * * * * * * View Detail 03 February 2023 CHAMBER BOARD MEETING DeMotte Chamber Office, 327 N. Halleck St., Demotte, Indiana * * * * * * View Detail 03 February 2023 CHAMBER BOARD MEETING DeMotte Chamber Office, 327 N. Halleck St., Demotte, Indiana * * * * * * View Detail No event found! COMMUNITY NUMBERS Emergency – Call 911 DeMotte Police Non-Emergency 219-987-3344 Keener Twp Ambulance Non-Emergency 219-987-2021 Keener Twp Fire Non-Emergency 219-987-2122 Government DeMotte License Branch 219-987-5141 DeMotte Parks 219-987-3831 DeMotte Post Office 219-987-3293 DeMotte Library 219-987-2221 DeMotte Town Hall 219-987-3831 Schools KV Superintendent 219-987-4711 DeMotte Christian High School 219-987-7652 DeMotte Christian School 219-987-3721 DeMotte Elementary School 219-987-2789 KV High School 219-956-3143 KV Intermediate School 219-987-2027 KV Middle School 219-956-3143 Spencer Pool 219-987-2906 DID YOU KNOW? CONTACT US DeMotte Chamber 327 N. Halleck St. DeMotte, IN 46310 (Located in the DeMotte Plaza) (219) 987-5800 info@demottechamber.org HOSTED BY BROWSE * About Us * Member Directory * Business in Motion * Calendar * ZZ Touch of Dutch * Photo Gallery * Contact Us CHAMBER HOURS Monday – 9:00am-1:00pm* Tuesday – 9:00am-1:00pm* Wednesday – CLOSED* Thursday – 9:00am-1:00pm* Friday – 9:00am-1:00pm* Saturday/Sunday: CLOSED (*or call for an appointment) © 2023 DeMotte Chamber of Commerce, DeMotte, IN * Facebook * Mail Scroll to top Contact Us Powered by