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Submission: On December 27 via manual from IN — Scanned from DE
Submission: On December 27 via manual from IN — Scanned from DE
Form analysis 1 forms found in the DOM
<form id="paymentForm" aria-label="payment-form">
<div class="row">
<div class="col-12 col-md-7 form-group">
<div class="ap-money-wrapper">
<div class="ap-money-prefix">
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class="ap-money-textbox " id="amountField" label="Payment Amount" name="amountField" placeholder="" required="" data-testid="ap-masked-input" value=""></div>
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<div class="row">
<div class="col-12 form-group">
<div class="ap-text-input-wrapper float-label labeled required" data-testid="ap-input-text"><label for="reference" class="ap-text-input-label" data-testid="ap-input-label">Client Name</label><input type="text" id="reference" label="Client Name"
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<div class="row">
<div class="col-12">
<h2>Additional Information</h2>
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<div class="col-12 form-group custom-text-field-container">
<div class="ap-text-input-wrapper float-label labeled" data-testid="ap-input-text"><label for="Invoice or Reference" class="ap-text-input-label" data-testid="ap-input-label">Invoice or Reference</label><input type="text"
id="Invoice or Reference" label="Invoice or Reference" name="Invoice or Reference" aria-required="false" aria-disabled="false" value=""></div>
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</div>
<div class="row">
<div class="col-12">
<h2>Payment Method</h2>
</div>
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<div class="ap-accordion Card " data-testid="Card-test-id">
<div class="ap-accordion-header" id="card-id" aria-expanded="false" aria-controls="card-content-id" tabindex="0">
<div class="ap-accordion-container">
<div class="ap-accordion-check "></div>
<div class="ap-accordion-headline">
<p class="ap-accordion-title">Card</p>
<div class="ap-accordion-subtitle">Debit and Credit accepted.</div>
</div>
</div>
<div class="ap-accordion-images-container"><img src="/assets/packs/media/paymentpagereact/visa-e5f49cb3.svg" class="ap-accordion-images" alt="Visa"><img src="/assets/packs/media/paymentpagereact/mastercard-66458aad.svg"
class="ap-accordion-images" alt="Master Card"><img src="/assets/packs/media/paymentpagereact/amex-b7bf1ae4.svg" class="ap-accordion-images" alt="American Express"><img src="/assets/packs/media/paymentpagereact/discover-04c123d6.svg"
class="ap-accordion-images" alt="Discover"></div>
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<div class="expanded-content" id="card-content-id" data-testid="accordion-content" aria-hidden="true" role="region" aria-labelledby="card-id">
<div class="row">
<div class="col-12 form-group">
<div class="ap-text-input-wrapper float-label labeled" data-testid="ap-input-text"><label for="cardName" class="ap-text-input-label" data-testid="ap-input-label">Name on Card</label><input type="text" id="cardName" label="Name on Card"
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<div class="col-12 col-sm-7 form-group">
<div class="ap-labeled-hosted-input"><label class="inline-label" id="card-number-label">Card Number</label>
<div id="cc_number" data-testid="cc_number" class="hosted-wrap col-10" aria-labelledby="card-number-label"><iframe sandbox="allow-scripts allow-same-origin" src="https://cdn.affinipay.com/hostedfields/1.4.0/field_1.4.0.html"></iframe>
</div>
<div class="input-card-icon generic-card" role="img" alt="credit cards logo" title="credit card logo"></div>
</div>
</div>
<div class="col-5 col-sm-2 form-group">
<div class="ap-labeled-hosted-input"><label class="inline-label" id="cvv-label">CVV</label>
<div id="cvv" data-testid="cvv" class="hosted-wrap " aria-labelledby="cvv-label"><iframe sandbox="allow-scripts allow-same-origin" src="https://cdn.affinipay.com/hostedfields/1.4.0/field_1.4.0.html"></iframe></div>
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<div class="col-7 col-sm-3 form-group">
<div class="ap-mask-input-wrapper float-label labeled required" data-testid="ap-masked-wrapper"><label for="cardExpiration" class="ap-mask-input-label" data-testid="ap-masked-label">Exp. Date</label><input type="text" class=""
id="cardExpiration" label="Exp. Date" name="cardExpiration" placeholder="" required="" data-testid="ap-masked-input" value=""></div>
</div>
<div class="billing-address row ">
<div class="col-12">
<h3>Billing Address</h3>
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<div class="col-12 form-group">
<div class="ap-text-input-wrapper float-label labeled required" data-testid="ap-input-text"><label for="cardBillingAddress" class="ap-text-input-label" data-testid="ap-input-label">Address</label><input type="text" id="cardBillingAddress"
label="Address" name="cardBillingAddress" required="" aria-required="true" aria-disabled="false" value=""></div>
</div>
<div class="col-12 form-group">
<div class="ap-text-input-wrapper float-label labeled" data-testid="ap-input-text"><label for="cardBillingAddress2" class="ap-text-input-label" data-testid="ap-input-label">Address 2</label><input type="text" id="cardBillingAddress2"
label="Address 2" name="cardBillingAddress2" aria-required="false" aria-disabled="false" value=""></div>
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<div class="col-12 col-sm-6 form-group">
<div class="ap-text-input-wrapper float-label labeled" data-testid="ap-input-text"><label for="cardBillingCity" class="ap-text-input-label" data-testid="ap-input-label">City</label><input type="text" id="cardBillingCity" label="City"
name="cardBillingCity" aria-required="false" aria-disabled="false" value=""></div>
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<div class="col-12 col-sm-6 form-group state-dropdown">
<div class="ap-select-wrap floating-label"><label id="downshift-0-label" for="downshift-0-toggle-button" class="ap-select-label">State</label><button id="downshift-0-toggle-button" aria-haspopup="listbox" aria-expanded="false"
aria-labelledby="downshift-0-label downshift-0-toggle-button" data-testid="combobox" class="ap-select-toggle" type="button">
<div class="ap-selected-text"></div>
</button>
<ul id="downshift-0-menu" role="listbox" aria-labelledby="downshift-0-label" tabindex="-1" class="ap-options"></ul>
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<div class="col-12 col-sm-6 form-group">
<div class="ap-text-input-wrapper float-label labeled required" data-testid="ap-input-text"><label for="cardBillingZip" class="ap-text-input-label" data-testid="ap-input-label">Zip / Postal Code</label><input type="text"
id="cardBillingZip" label="Zip / Postal Code" name="cardBillingZip" required="" aria-required="true" aria-disabled="false" value=""></div>
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<div class="col-12 col-sm-6 form-group">
<div class="ap-select-wrap floating-label selected"><label id="downshift-1-label" for="downshift-1-toggle-button" class="ap-select-label">Country</label><button id="downshift-1-toggle-button" aria-haspopup="listbox" aria-expanded="false"
aria-labelledby="downshift-1-label downshift-1-toggle-button" data-testid="combobox" class="ap-select-toggle" type="button">
<div class="ap-selected-text">United States</div>
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<ul id="downshift-1-menu" role="listbox" aria-labelledby="downshift-1-label" tabindex="-1" class="ap-options"></ul>
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<div class="col-12 form-group ">
<div class="ap-text-input-wrapper float-label labeled" data-testid="ap-input-text"><label for="cardEmail" class="ap-text-input-label" data-testid="ap-input-label">Receipt Email</label><input type="text" id="cardEmail"
label="Receipt Email" name="cardEmail" aria-required="false" aria-disabled="false" value=""></div>
</div>
</div>
</div>
<div class="payment-summary-subtotals">
<div class="payment-summary-description">
<div data-testid="summary-payment-amount">Payment</div>
<div data-testid="subtotal">$0.00</div>
</div>
</div>
<div class="row">
<div class="col-12 text-center text-md-right"><button class="ap-button ap-primary-button submitButton" aria-disabled="false" aria-label="" aria-describedby="" type="submit" data-testid="submit-btn-card">Pay $0.00</button></div>
</div>
<div class="row">
<div class="col-12 payment-disclaimer">By clicking on the Pay Button, you agree to pay the above amount and provide your information to help us process your payment and detect fraud. Please see our
<a href="https://lawpay.com/terms/privacy/" rel="noopener noreferrer" target="_blank">Privacy Policy</a> for more information on our data practices.</div>
</div>
</div>
</div>
</form>Text Content
JAVASCRIPT IS DISABLED! Please enable Javascript in your browser, then refresh the page. Javascript is required to run this website. MendenFreiman LLP 5565 Glenridge Connector Ste. 1000 Atlanta, GA 30342 (770) 379-1450 sbennett@mfcounsel.com https://mfcounsel.com/ INVOICE PAYMENT Payment Detail MendenFreiman LLP Payment Amount Client Name ADDITIONAL INFORMATION Invoice or Reference PAYMENT METHOD Card Debit and Credit accepted. Name on Card Card Number CVV Exp. Date BILLING ADDRESS Address Address 2 City State Zip / Postal Code Country United States Receipt Email Payment $0.00 Pay $0.00 By clicking on the Pay Button, you agree to pay the above amount and provide your information to help us process your payment and detect fraud. Please see our Privacy Policy for more information on our data practices. Our system uses SSL encryption technology, which is the same technology banks use to protect sensitive information.