mysparkspayments.com Open in urlscan Pro
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<form action="/" autocomplete="off" id="main-form" method="post" novalidate="novalidate">
  <div class="container">
    <div class="row">
      <div class="col-md-4 form-group">
        <h5>PAY INVOICE</h5>
      </div>
    </div>
    <div class="row">
      <div class="col-md-12 form-group">
        <p>Before proceeding please have all necessary information available: Invoice #, Job Number (not required), PO number (if available)</p>
        <p>Please call 800-471-9617 with any questions or concerns you may have.</p>
      </div>
    </div>
    <div class="row">
      <div class="col-md-4 form-group">
        <label for="CompanyName">Company Name <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The Company Name field is required." id="CompanyName" name="CompanyName" type="text" value="">
      </div>
      <div class="col-md-4 form-group">
        <label for="ClientPoNumber">Client PO Number</label>
        <input autocomplete="off" class="form-control" id="ClientPoNumber" name="ClientPoNumber" type="text" value="">
      </div>
      <div class="col-md-4 form-group">
        <label for="InvoiceNo">Sparks Invoice Number <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The Invoice Number field is required." id="InvoiceNo" name="InvoiceNo" type="text" value="">
      </div>
    </div>
    <div class="row">
      <div class="col-md-4 form-group">
        <label for="JobNumber">Sparks Job Number</label>
        <input autocomplete="off" class="form-control" id="JobNumber" name="JobNumber" type="text" value="">
      </div>
      <div class="col-md-4 form-group">
        <label for="ClientRef">Client Reference</label>
        <textarea autocomplete="off" class="form-control" cols="20" id="ClientRef" name="ClientRef" rows="2"></textarea>
      </div>
      <div class="col-md-4 form-group">
      </div>
    </div>
    <div class="row">
      <div class="col-md-4 form-group">
        <label for="TotalAmount">Total Amount <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-number="The field Total Amount must be a number." data-val-required="The Total Amount field is required." id="TotalAmount" name="TotalAmount"
          onkeypress="return isNumberKeyOrDecimal(event)" type="text" value="">
      </div>
      <div class="col-md-4 form-group">
        <label for="PayAmount">Pay Amount <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-number="The field Pay Amount must be a number." data-val-required="The Pay Amount field is required." id="PayAmount" name="PayAmount"
          onkeypress="return isNumberKeyOrDecimal(event)" type="text" value="">
      </div>
      <div class="col-md-4 form-group">
      </div>
    </div>
    <div class="row">
      <div class="col-md-4 form-group">
        <h5>CREDIT CARD INFORMATION:</h5>
      </div>
    </div>
    <div class="row">
      <div class="col-md-4 form-group">
        <label for="NameOnCard">Name On Card <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The Name On Card field is required." id="NameOnCard" name="NameOnCard" type="text" value="">
      </div>
      <div class="col-md-4 form-group">
        <label for="CardType">Select Card Type <span class="required-text">*</span></label>
        <select class="form-control required" id="CardType" name="CardType" autocomplete="off">
          <option value="" label="Select"></option>
          <option value="Unknown" label="Unknown">Unknown</option>
          <option value="Visa" label="Visa">Visa</option>
          <option value="MasterCard" label="MasterCard">MasterCard</option>
          <option value="Discover" label="Discover">Discover</option>
          <option value="AmericanExpress" label="AmericanExpress">AmericanExpress</option>
        </select>
      </div>
      <div class="col-md-4 form-group">
        <label for="CardNumber">Card Number <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The CardNumber field is required." id="CardNumber" name="CardNumber" onkeypress="return isNumberKeyOrDecimal(event)" type="text" value="">
      </div>
    </div>
    <div class="row">
      <div class="col-sm-4 form-group">
        <label for="ExpMonth">Exp. Month <span class="required-text">*</span></label>
        <select class="form-control required" id="ExpMonth" name="ExpMonth" autocomplete="off">
          <option value="" label="Select"></option>
          <option value="01" label="January">January</option>
          <option value="02" label="February">February</option>
          <option value="03" label="March">March</option>
          <option value="04" label="April">April</option>
          <option value="05" label="May">May</option>
          <option value="06" label="June">June</option>
          <option value="07" label="July">July</option>
          <option value="08" label="August">August</option>
          <option value="09" label="September">September</option>
          <option value="10" label="October">October</option>
          <option value="11" label="November">November</option>
          <option value="12" label="December">December</option>
        </select>
      </div>
      <div class="col-sm-4 form-group">
        <label for="ExpYear">Exp. Year <span class="required-text">*</span></label>
        <select class="form-control required" id="ExpYear" name="ExpYear" autocomplete="off">
          <option value="" label="Select"></option>
          <option value="2024" label="2024">2024</option>
          <option value="2025" label="2025">2025</option>
          <option value="2026" label="2026">2026</option>
          <option value="2027" label="2027">2027</option>
          <option value="2028" label="2028">2028</option>
          <option value="2029" label="2029">2029</option>
          <option value="2030" label="2030">2030</option>
          <option value="2031" label="2031">2031</option>
          <option value="2032" label="2032">2032</option>
          <option value="2033" label="2033">2033</option>
          <option value="2034" label="2034">2034</option>
        </select>
      </div>
      <div class="col-sm-4 form-group">
        <label for="CvcCode">CVV/CVC Code <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The CvcCode field is required." id="CvcCode" name="CvcCode" type="text" value="">
      </div>
    </div>
    <div class="row">
      <div class="col-md-8 form-group">
        <p>There will be a 2% service fee on all credit card transactions</p>
      </div>
    </div>
    <div class="row">
      <div class="col-md-2 form-group">
        <label for="TransactionFee">Transaction Fee</label>
        <input autocomplete="off" class="form-control" id="TransactionFee" name="TransactionFee" readonly="readonly" type="text" value="">
      </div>
      <div class="col-md-2 form-group">
        <label for="TotalTransaction">Total Transaction</label>
        <input autocomplete="off" class="form-control" id="TotalTransaction" name="TotalTransaction" readonly="readonly" type="text" value="">
      </div>
    </div>
    <div class="row">
      <div class="col-md-4 form-group">
        <h5>CLIENT INFORMATION:</h5>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-4 form-group">
        <label for="FirstName">First Name <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The First Name field is required." id="FirstName" name="FirstName" type="text" value="">
      </div>
      <div class="col-sm-4 form-group">
        <label for="LastName">Last Name <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The Last Name field is required." id="LastName" name="LastName" type="text" value="">
      </div>
      <div class="col-sm-4 form-group">
      </div>
    </div>
    <div class="row">
      <div class="col-sm-4 form-group">
        <label for="Country">Country <span class="required-text">*</span></label>
        <select class="form-control required" id="Country" name="Country" autocomplete="off">
          <option value="" label="Select"></option>
          <option value="USA" label="United States of America">United States of America</option>
          <option value="AFG" label="Afghanistan">Afghanistan</option>
          <option value="ALB" label="Albania">Albania</option>
          <option value="DZA" label="Algeria">Algeria</option>
          <option value="ASM" label="American Samoa">American Samoa</option>
          <option value="AND" label="Andorra">Andorra</option>
          <option value="AGO" label="Angola">Angola</option>
          <option value="AIA" label="Anguilla">Anguilla</option>
          <option value="ATA" label="Antarctica">Antarctica</option>
          <option value="ATG" label="Antigua and Barbuda">Antigua and Barbuda</option>
          <option value="ARG" label="Argentina">Argentina</option>
          <option value="ARM" label="Armenia">Armenia</option>
          <option value="ABW" label="Aruba">Aruba</option>
          <option value="AUS" label="Australia">Australia</option>
          <option value="AUT" label="Austria">Austria</option>
          <option value="AZE" label="Azerbaijan">Azerbaijan</option>
          <option value="BHS" label="Bahamas">Bahamas</option>
          <option value="BHR" label="Bahrain">Bahrain</option>
          <option value="BGD" label="Bangladesh">Bangladesh</option>
          <option value="BRB" label="Barbados">Barbados</option>
          <option value="BLR" label="Belarus">Belarus</option>
          <option value="BEL" label="Belgium">Belgium</option>
          <option value="BLZ" label="Belize">Belize</option>
          <option value="BEN" label="Benin">Benin</option>
          <option value="BMU" label="Bermuda">Bermuda</option>
          <option value="BTN" label="Bhutan">Bhutan</option>
          <option value="BOL" label="Bolivia (Plurinational State of)">Bolivia (Plurinational State of)</option>
          <option value="BES" label="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
          <option value="BIH" label="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
          <option value="BWA" label="Botswana">Botswana</option>
          <option value="BVT" label="Bouvet Island">Bouvet Island</option>
          <option value="BRA" label="Brazil">Brazil</option>
          <option value="IOT" label="British Indian Ocean Territory">British Indian Ocean Territory</option>
          <option value="BRN" label="Brunei Darussalam">Brunei Darussalam</option>
          <option value="BGR" label="Bulgaria">Bulgaria</option>
          <option value="BFA" label="Burkina Faso">Burkina Faso</option>
          <option value="BDI" label="Burundi">Burundi</option>
          <option value="CPV" label="Cabo Verde">Cabo Verde</option>
          <option value="KHM" label="Cambodia">Cambodia</option>
          <option value="CMR" label="Cameroon">Cameroon</option>
          <option value="CAN" label="Canada">Canada</option>
          <option value="CYM" label="Cayman Islands">Cayman Islands</option>
          <option value="CAF" label="Central African Republic">Central African Republic</option>
          <option value="TCD" label="Chad">Chad</option>
          <option value="CHL" label="Chile">Chile</option>
          <option value="CHN" label="China">China</option>
          <option value="CXR" label="Christmas Island">Christmas Island</option>
          <option value="CCK" label="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
          <option value="COL" label="Colombia">Colombia</option>
          <option value="COM" label="Comoros">Comoros</option>
          <option value="COG" label="Congo">Congo</option>
          <option value="COD" label="Congo (Democratic Republic of the)">Congo (Democratic Republic of the)</option>
          <option value="COK" label="Cook Islands">Cook Islands</option>
          <option value="CRI" label="Costa Rica">Costa Rica</option>
          <option value="HRV" label="Croatia">Croatia</option>
          <option value="CUB" label="Cuba">Cuba</option>
          <option value="CUW" label="Curaçao">Curaçao</option>
          <option value="CYP" label="Cyprus">Cyprus</option>
          <option value="CZE" label="Czechia">Czechia</option>
          <option value="CIV" label="Côte d'Ivoire">Côte d'Ivoire</option>
          <option value="DNK" label="Denmark">Denmark</option>
          <option value="DJI" label="Djibouti">Djibouti</option>
          <option value="DMA" label="Dominica">Dominica</option>
          <option value="DOM" label="Dominican Republic">Dominican Republic</option>
          <option value="ECU" label="Ecuador">Ecuador</option>
          <option value="EGY" label="Egypt">Egypt</option>
          <option value="SLV" label="El Salvador">El Salvador</option>
          <option value="GNQ" label="Equatorial Guinea">Equatorial Guinea</option>
          <option value="ERI" label="Eritrea">Eritrea</option>
          <option value="EST" label="Estonia">Estonia</option>
          <option value="ETH" label="Ethiopia">Ethiopia</option>
          <option value="FLK" label="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
          <option value="FRO" label="Faroe Islands">Faroe Islands</option>
          <option value="FJI" label="Fiji">Fiji</option>
          <option value="FIN" label="Finland">Finland</option>
          <option value="FRA" label="France">France</option>
          <option value="GUF" label="French Guiana">French Guiana</option>
          <option value="PYF" label="French Polynesia">French Polynesia</option>
          <option value="ATF" label="French Southern Territories">French Southern Territories</option>
          <option value="GAB" label="Gabon">Gabon</option>
          <option value="GMB" label="Gambia">Gambia</option>
          <option value="GEO" label="Georgia">Georgia</option>
          <option value="DEU" label="Germany">Germany</option>
          <option value="GHA" label="Ghana">Ghana</option>
          <option value="GIB" label="Gibraltar">Gibraltar</option>
          <option value="GRC" label="Greece">Greece</option>
          <option value="GRL" label="Greenland">Greenland</option>
          <option value="GRD" label="Grenada">Grenada</option>
          <option value="GLP" label="Guadeloupe">Guadeloupe</option>
          <option value="GUM" label="Guam">Guam</option>
          <option value="GTM" label="Guatemala">Guatemala</option>
          <option value="GGY" label="Guernsey">Guernsey</option>
          <option value="GIN" label="Guinea">Guinea</option>
          <option value="GNB" label="Guinea-Bissau">Guinea-Bissau</option>
          <option value="GUY" label="Guyana">Guyana</option>
          <option value="HTI" label="Haiti">Haiti</option>
          <option value="HMD" label="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
          <option value="VAT" label="Holy See">Holy See</option>
          <option value="HND" label="Honduras">Honduras</option>
          <option value="HKG" label="Hong Kong">Hong Kong</option>
          <option value="HUN" label="Hungary">Hungary</option>
          <option value="ISL" label="Iceland">Iceland</option>
          <option value="IND" label="India">India</option>
          <option value="IDN" label="Indonesia">Indonesia</option>
          <option value="IRN" label="Iran (Islamic Republic of)">Iran (Islamic Republic of)</option>
          <option value="IRQ" label="Iraq">Iraq</option>
          <option value="IRL" label="Ireland">Ireland</option>
          <option value="IMN" label="Isle of Man">Isle of Man</option>
          <option value="ISR" label="Israel">Israel</option>
          <option value="ITA" label="Italy">Italy</option>
          <option value="JAM" label="Jamaica">Jamaica</option>
          <option value="JPN" label="Japan">Japan</option>
          <option value="JEY" label="Jersey">Jersey</option>
          <option value="JOR" label="Jordan">Jordan</option>
          <option value="KAZ" label="Kazakhstan">Kazakhstan</option>
          <option value="KEN" label="Kenya">Kenya</option>
          <option value="KIR" label="Kiribati">Kiribati</option>
          <option value="PRK" label="Korea (Democratic People's Republic of)">Korea (Democratic People's Republic of)</option>
          <option value="KOR" label="Korea (Republic of)">Korea (Republic of)</option>
          <option value="KWT" label="Kuwait">Kuwait</option>
          <option value="KGZ" label="Kyrgyzstan">Kyrgyzstan</option>
          <option value="LAO" label="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
          <option value="LVA" label="Latvia">Latvia</option>
          <option value="LBN" label="Lebanon">Lebanon</option>
          <option value="LSO" label="Lesotho">Lesotho</option>
          <option value="LBR" label="Liberia">Liberia</option>
          <option value="LBY" label="Libya">Libya</option>
          <option value="LIE" label="Liechtenstein">Liechtenstein</option>
          <option value="LTU" label="Lithuania">Lithuania</option>
          <option value="LUX" label="Luxembourg">Luxembourg</option>
          <option value="MAC" label="Macao">Macao</option>
          <option value="MDG" label="Madagascar">Madagascar</option>
          <option value="MWI" label="Malawi">Malawi</option>
          <option value="MYS" label="Malaysia">Malaysia</option>
          <option value="MDV" label="Maldives">Maldives</option>
          <option value="MLI" label="Mali">Mali</option>
          <option value="MLT" label="Malta">Malta</option>
          <option value="MHL" label="Marshall Islands">Marshall Islands</option>
          <option value="MTQ" label="Martinique">Martinique</option>
          <option value="MRT" label="Mauritania">Mauritania</option>
          <option value="MUS" label="Mauritius">Mauritius</option>
          <option value="MYT" label="Mayotte">Mayotte</option>
          <option value="MEX" label="Mexico">Mexico</option>
          <option value="FSM" label="Micronesia (Federated States of)">Micronesia (Federated States of)</option>
          <option value="MDA" label="Moldova (Republic of)">Moldova (Republic of)</option>
          <option value="MCO" label="Monaco">Monaco</option>
          <option value="MNG" label="Mongolia">Mongolia</option>
          <option value="MNE" label="Montenegro">Montenegro</option>
          <option value="MSR" label="Montserrat">Montserrat</option>
          <option value="MAR" label="Morocco">Morocco</option>
          <option value="MOZ" label="Mozambique">Mozambique</option>
          <option value="MMR" label="Myanmar">Myanmar</option>
          <option value="NAM" label="Namibia">Namibia</option>
          <option value="NRU" label="Nauru">Nauru</option>
          <option value="NPL" label="Nepal">Nepal</option>
          <option value="NLD" label="Netherlands">Netherlands</option>
          <option value="NCL" label="New Caledonia">New Caledonia</option>
          <option value="NZL" label="New Zealand">New Zealand</option>
          <option value="NIC" label="Nicaragua">Nicaragua</option>
          <option value="NER" label="Niger">Niger</option>
          <option value="NGA" label="Nigeria">Nigeria</option>
          <option value="NIU" label="Niue">Niue</option>
          <option value="NFK" label="Norfolk Island">Norfolk Island</option>
          <option value="MNP" label="Northern Mariana Islands">Northern Mariana Islands</option>
          <option value="NOR" label="Norway">Norway</option>
          <option value="OMN" label="Oman">Oman</option>
          <option value="PAK" label="Pakistan">Pakistan</option>
          <option value="PLW" label="Palau">Palau</option>
          <option value="PSE" label="Palestine, State of">Palestine, State of</option>
          <option value="PAN" label="Panama">Panama</option>
          <option value="PNG" label="Papua New Guinea">Papua New Guinea</option>
          <option value="PRY" label="Paraguay">Paraguay</option>
          <option value="PER" label="Peru">Peru</option>
          <option value="PHL" label="Philippines">Philippines</option>
          <option value="PCN" label="Pitcairn">Pitcairn</option>
          <option value="POL" label="Poland">Poland</option>
          <option value="PRT" label="Portugal">Portugal</option>
          <option value="PRI" label="Puerto Rico">Puerto Rico</option>
          <option value="QAT" label="Qatar">Qatar</option>
          <option value="MKD" label="Republic of North Macedonia">Republic of North Macedonia</option>
          <option value="ROU" label="Romania">Romania</option>
          <option value="RUS" label="Russian Federation">Russian Federation</option>
          <option value="RWA" label="Rwanda">Rwanda</option>
          <option value="REU" label="Réunion">Réunion</option>
          <option value="BLM" label="Saint Barthélemy">Saint Barthélemy</option>
          <option value="SHN" label="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
          <option value="KNA" label="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
          <option value="LCA" label="Saint Lucia">Saint Lucia</option>
          <option value="MAF" label="Saint Martin (French part)">Saint Martin (French part)</option>
          <option value="SPM" label="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
          <option value="VCT" label="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
          <option value="WSM" label="Samoa">Samoa</option>
          <option value="SMR" label="San Marino">San Marino</option>
          <option value="STP" label="Sao Tome and Principe">Sao Tome and Principe</option>
          <option value="SAU" label="Saudi Arabia">Saudi Arabia</option>
          <option value="SEN" label="Senegal">Senegal</option>
          <option value="SRB" label="Serbia">Serbia</option>
          <option value="SYC" label="Seychelles">Seychelles</option>
          <option value="SLE" label="Sierra Leone">Sierra Leone</option>
          <option value="SGP" label="Singapore">Singapore</option>
          <option value="SXM" label="Sint Maarten (Dutch part)">Sint Maarten (Dutch part)</option>
          <option value="SVK" label="Slovakia">Slovakia</option>
          <option value="SVN" label="Slovenia">Slovenia</option>
          <option value="SLB" label="Solomon Islands">Solomon Islands</option>
          <option value="SOM" label="Somalia">Somalia</option>
          <option value="ZAF" label="South Africa">South Africa</option>
          <option value="SGS" label="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
          <option value="SSD" label="South Sudan">South Sudan</option>
          <option value="ESP" label="Spain">Spain</option>
          <option value="LKA" label="Sri Lanka">Sri Lanka</option>
          <option value="SDN" label="Sudan">Sudan</option>
          <option value="SUR" label="Suriname">Suriname</option>
          <option value="SJM" label="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
          <option value="SWE" label="Sweden">Sweden</option>
          <option value="CHE" label="Switzerland">Switzerland</option>
          <option value="SYR" label="Syrian Arab Republic">Syrian Arab Republic</option>
          <option value="TWN" label="Taiwan">Taiwan</option>
          <option value="TJK" label="Tajikistan">Tajikistan</option>
          <option value="TZA" label="Tanzania, United Republic of">Tanzania, United Republic of</option>
          <option value="THA" label="Thailand">Thailand</option>
          <option value="TLS" label="Timor-Leste">Timor-Leste</option>
          <option value="TGO" label="Togo">Togo</option>
          <option value="TKL" label="Tokelau">Tokelau</option>
          <option value="TON" label="Tonga">Tonga</option>
          <option value="TTO" label="Trinidad and Tobago">Trinidad and Tobago</option>
          <option value="TUN" label="Tunisia">Tunisia</option>
          <option value="TUR" label="Turkey">Turkey</option>
          <option value="TKM" label="Turkmenistan">Turkmenistan</option>
          <option value="TCA" label="Turks and Caicos Islands">Turks and Caicos Islands</option>
          <option value="TUV" label="Tuvalu">Tuvalu</option>
          <option value="UGA" label="Uganda">Uganda</option>
          <option value="UKR" label="Ukraine">Ukraine</option>
          <option value="ARE" label="United Arab Emirates">United Arab Emirates</option>
          <option value="GBR" label="United Kingdom of Great Britain and Northern Ireland">United Kingdom of Great Britain and Northern Ireland</option>
          <option value="UMI" label="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
          <option value="URY" label="Uruguay">Uruguay</option>
          <option value="UZB" label="Uzbekistan">Uzbekistan</option>
          <option value="VUT" label="Vanuatu">Vanuatu</option>
          <option value="VEN" label="Venezuela (Bolivarian Republic of)">Venezuela (Bolivarian Republic of)</option>
          <option value="VNM" label="Viet Nam">Viet Nam</option>
          <option value="VGB" label="Virgin Islands (British)">Virgin Islands (British)</option>
          <option value="VIR" label="Virgin Islands (U.S.)">Virgin Islands (U.S.)</option>
          <option value="WLF" label="Wallis and Futuna">Wallis and Futuna</option>
          <option value="ESH" label="Western Sahara">Western Sahara</option>
          <option value="YEM" label="Yemen">Yemen</option>
          <option value="ZMB" label="Zambia">Zambia</option>
          <option value="ZWE" label="Zimbabwe">Zimbabwe</option>
        </select>
      </div>
      <div class="col-sm-4 form-group">
        <label for="Address">Address <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The Address field is required." id="Address" name="Address" type="text" value="">
      </div>
      <div class="col-sm-4 form-group">
        <label for="City">City <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The City field is required." id="City" name="City" type="text" value="">
      </div>
    </div>
    <div class="row">
      <div class="col-sm-4 form-group">
        <label for="State">State/Province <span class="required-text">*</span></label>
        <select class="form-control required" id="State" name="State" autocomplete="off">
          <option value="" label="Select"></option>
          <option value="NON-US" label="NON-US">NON-US</option>
          <option value="AK" label="AK">AK</option>
          <option value="AL" label="AL">AL</option>
          <option value="AZ" label="AZ">AZ</option>
          <option value="AR" label="AR">AR</option>
          <option value="CA" label="CA">CA</option>
          <option value="CO" label="CO">CO</option>
          <option value="CT" label="CT">CT</option>
          <option value="DC" label="DC">DC</option>
          <option value="DE" label="DE">DE</option>
          <option value="FL" label="FL">FL</option>
          <option value="GA" label="GA">GA</option>
          <option value="HI" label="HI">HI</option>
          <option value="ID" label="ID">ID</option>
          <option value="IL" label="IL">IL</option>
          <option value="IN" label="IN">IN</option>
          <option value="IA" label="IA">IA</option>
          <option value="KS" label="KS">KS</option>
          <option value="KY" label="KY">KY</option>
          <option value="LA" label="LA">LA</option>
          <option value="ME" label="ME">ME</option>
          <option value="MD" label="MD">MD</option>
          <option value="MA" label="MA">MA</option>
          <option value="MI" label="MI">MI</option>
          <option value="MN" label="MN">MN</option>
          <option value="MS" label="MS">MS</option>
          <option value="MO" label="MO">MO</option>
          <option value="MT" label="MT">MT</option>
          <option value="NE" label="NE">NE</option>
          <option value="NV" label="NV">NV</option>
          <option value="NH" label="NH">NH</option>
          <option value="NJ" label="NJ">NJ</option>
          <option value="NM" label="NM">NM</option>
          <option value="NY" label="NY">NY</option>
          <option value="NC" label="NC">NC</option>
          <option value="ND" label="ND">ND</option>
          <option value="OH" label="OH">OH</option>
          <option value="OK" label="OK">OK</option>
          <option value="OR" label="OR">OR</option>
          <option value="PA" label="PA">PA</option>
          <option value="RI" label="RI">RI</option>
          <option value="SC" label="SC">SC</option>
          <option value="SD" label="SD">SD</option>
          <option value="TN" label="TN">TN</option>
          <option value="TX" label="TX">TX</option>
          <option value="UT" label="UT">UT</option>
          <option value="VT" label="VT">VT</option>
          <option value="VA" label="VA">VA</option>
          <option value="WA" label="WA">WA</option>
          <option value="WV" label="WV">WV</option>
          <option value="WI" label="WI">WI</option>
          <option value="WY" label="WY">WY</option>
        </select>
      </div>
      <div class="col-sm-4 form-group">
        <label for="PostalCode">Zip/Postal Code <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The Postal Code field is required." id="PostalCode" name="PostalCode" type="text" value="">
      </div>
      <div class="col-sm-4 form-group">
        <label for="Phone">Phone Number <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-required="The Phone field is required." id="Phone" name="Phone" type="text" value="">
      </div>
    </div>
    <div class="row">
      <div class="col-sm-4 form-group">
        <label for="Fax">Fax Number</label>
        <input autocomplete="off" class="form-control" id="Fax" name="Fax" type="text" value="">
      </div>
      <div class="col-sm-4 form-group">
        <label for="Email">Email Address <span class="required-text">*</span></label>
        <input autocomplete="off" class="form-control" data-val="true" data-val-email="The Email field is not a valid e-mail address." data-val-required="The Email field is required." id="Email" name="Email" type="text" value="">
      </div>
      <div class="col-sm-4 form-group">
        <label for="Website">Website Address</label>
        <input autocomplete="off" class="form-control" id="Website" name="Website" type="text" value="">
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12 form-group">
        <p id="captchaError" style="color: red; font-weight: bold; display: none;"> Please answer the reCAPTCHA below. </p>
        <script type="text/javascript" src="https://www.google.com/recaptcha/api.js"></script>
        <div class="g-recaptcha" data-sitekey="6Lf3_hUqAAAAADyZAv6p0UoqMlbFxq1kR_bwBa_X">
          <div style="width: 304px; height: 78px;">
            <div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-ssnf3ashccqh" frameborder="0" scrolling="no"
                sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
                src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6Lf3_hUqAAAAADyZAv6p0UoqMlbFxq1kR_bwBa_X&amp;co=aHR0cHM6Ly9teXNwYXJrc3BheW1lbnRzLmNvbTo0NDM.&amp;hl=de&amp;v=hfUfsXWZFeg83qqxrK27GB8P&amp;size=normal&amp;cb=ic21zxd84kq0"></iframe>
            </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
              style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
          </div><iframe style="display: none;"></iframe>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-md-4 form-group">
        <button type="submit" class="btn btn-success" id="submitBtn">Process</button>
      </div>
    </div>
  </div>
</form>

Text Content

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Client PO Number
Sparks Invoice Number *
Sparks Job Number
Client Reference

Total Amount *
Pay Amount *


CREDIT CARD INFORMATION:

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CLIENT INFORMATION:

First Name *
Last Name *

Country * United States of America Afghanistan Albania Algeria American Samoa
Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba
Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium
Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint
Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British
Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo
Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad
Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo
Congo (Democratic Republic of the) Cook Islands Costa Rica Croatia Cuba Curaçao
Cyprus Czechia Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic
Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland
Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French
Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana
Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea
Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras
Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq
Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya
Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait
Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya
Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives
Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico
Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia
Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands
New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern
Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New
Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar
Republic of North Macedonia Romania Russian Federation Rwanda Réunion Saint
Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis
Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent
and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal
Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia
Slovenia Solomon Islands Somalia South Africa South Georgia and the South
Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan
Mayen Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United
Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia
Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab
Emirates United Kingdom of Great Britain and Northern Ireland United States
Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic
of) Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna
Western Sahara Yemen Zambia Zimbabwe
Address *
City *
State/Province * NON-US AK AL AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA
ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT
VA WA WV WI WY
Zip/Postal Code *
Phone Number *
Fax Number
Email Address *
Website Address

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