A1 Realty Listing

Payment Form

Using the information you provide, you authorize us to produce a one-time legal credit card charge for this payment only.

Please check over the information above carefully before submitting this form.
Listing / AD Type:
For a listing renewal you should complete the Renewal Form so your payment can easily be associated with your current listing or ad.

Database Listing(s):
Realty Professional Listing:

Property Listing:
No. of Property Listings:

Rental Listing:
No. of Rental Listings:

Email Advertising:
Ad Duration (months):
Database Choice:

Banner Advertising:
Ad Duration (months):

Payment Information:
Credit Card Type:
Card Number:
Expiration Date:	(mmyy)
Order Total:	$

Billing Information: (used to validate Credit Card information)
Listing ID:
Full Name:
Company:
Address:
City:
State:	Zip Code:
Country:
Phone:	(include area code)
Fax:
Email:

Comments: