Utility Payment Form – Gravity Forms Hacks

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Account Number*

Amount Due*

Credit Card Details*

Card Details

Cardholder Name

Test this form using card # 4242 4242 4242 4242, any 3 digits for CVV and any future date

Payment Total

Consent*

I agree to the terms and conditions.

By placing your utility payment online, you are agreeing to our terms and conditions as explained here.