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 - enter a whole number without comma or decimal):
$

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.