Payment For: Patterson LA General Payments - 207703

VISA, Mastercard, Discover, and American Express are accepted. Your credit card statement will reflect a charge to MCM*.

Payment will be sent to
Patterson LA
1314 Main Street
PO Box 367
Patterson, LA 70392

ATTENTION: This form is for general payments, NOT Utility payments. If you need to make a Utility payment, please make it on form 207702. If a Utility payment is made on this form, it will not be applied correctly to your utility account and you run the risk of having your water turned off.

THIS FORM IS NOT FOR UTILITY PAYMENTS, PLEASE MAKE UTILITY PAYMENTS ON FORM 207702

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Transaction Information

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Permit Number :

Cardholder Phone Number: *

I understand that the payment I'm making is not for a utility: *

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Credit Card Information

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First & Last Name Only - Do not include a middle name or initial

Credit Card Number:*

Expiration:*

CVV:*

Card Type:*

Billing Information

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Country:*

Email Address:*

Used to email receipt to payor.

Fees associated with using Utilipay

Min	Max	Amount
$ 0.00	$ 100,000.00	3.00% + $0.40
Over $ 100,000.00		3% + $0.40

Additional Fee: $0.40

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Payment For: Patterson LA General Payments - 207703

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