Payment Form

thank you
Type of Card:
Credit Card Number:
Expiration Date:
3 Digit Code:
Name of Cardholder:
Billing Address:
Signature of Cardholder:
By signing this, I acknowledge the charges described in my estimate and assume full responsibility for said charges and agree to honor and abide by the terms of payment. I authorize MaidPure to add a 4% convenience fee to my final bill if I choose to pay by credit card. *
Please let us know how you would like to pay for your cleanings:
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