Name (company or individual):

Invoice Number:
  You must enter your invoice number exactly as it appears on your bill. The form will reset if the invoice number is incorrect.

Invoice Amount (invoice total, including tax and shipping, if any):

Sales Tax (enter amount shown on invoice, 0.00 if none shown)

Note: After clicking on Continue below, you will be forwarded to an external site which will collect your credit card information.

Instructions for Filling Out the Virtual Merchant Online Form: (You may want to print this out as a reference prior to going to the external site.)

Important: do not use the back, forward, or refresh buttons while filling out the online form. This may cause multiple charges to your credit card.

ORDER SECTION:
Credit Card Number: enter 16-digit credit card number, no spaces or dashes
Card Security Code: the 3-digit number on the reverse side of the credit card at the end of the signature line
Sales tax: enter amount shown on invoice, if any (this amount is also included in the invoice total above)

BILLING ADDRESS:
Fill in the two required fields (marked with a red star)

    

Return/refund policy: all sales are final. If a physical item is defective, we will replace it if possible. If not possible we will refund the purchase price.

Privacy statement: We do not share any customer information outside the University of Washington.