Goodman Frost PLLC
Secure Payment Form

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Payment Summary:
Date: 05/30/23
Account Number:  
Credit Card Information:
Card Type:

Name on Credit Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
[What is the Card ID?]
Phone Number:
Email Address:

This is a communication from a debt collector. This is an attempt To collect a debt and any information obtained will be used for that purpose.