Usio - Hosted Payment Pages

Interest payments made after the 5th of each month may incur a late charge.

Refunds are handled on a case by case basis

Account Information:

Loan/Invoice Number:

Account Holder Information:

First Name:

Last Name:

Address:

City:

State:

Zip:

Email for receipt:

Amount (format 0.00):

Fee Amount:

Total Amount:

We impose a surcharge on credit cards that is not greater than our cost of acceptance

Payment Type:

Credit/Debit Card Electronic Check

Card Type:

Credit Card Number:

Credit Card Expiration:

Credit Card CVC:

Bank Account Type:

Bank Routing Number:

Bank Account Number:

Usio, Inc. processes ACH transactions on behalf of Eastside Funding. By clicking ‘Submit’ below you agree to pay via this ACH Authorization. You acknowledge that you are voluntarily choosing to pay electronically. You understand and acknowledge that you may terminate the ACH Authorization by notifying us at support@usio.com, subject: ACH Authorization Disputes, and in such time and manner as to afford us and your bank a reasonable opportunity to act on it.