Jay Mitchell Associates

Express Pay

Use this page to send payment information for prearranged products and services.

PERSONAL INFORMATION

Name
Address
City
State
Zip code
Phone
E-mail

PAYMENT INFORMATION

Type of credit card	American Express MasterCard Discover Visa
Name on Card
AMEX card number	--
DISCOVER/MC/VISA number	---
Expiration date MM/YY	/
Total amount to be charged	$

Clicking the "Submit" button authorizes Jay Mitchell Associates to charge your credit card the amount you entered.