{"id":3149,"date":"2026-03-02T03:58:57","date_gmt":"2026-03-02T03:58:57","guid":{"rendered":"https:\/\/latinoexpressinsurance.com\/?page_id=3149"},"modified":"2026-03-02T04:00:05","modified_gmt":"2026-03-02T04:00:05","slug":"make-a-payment","status":"publish","type":"page","link":"https:\/\/latinoexpressinsurance.com\/en\/make-a-payment\/","title":{"rendered":"Make a Payment"},"content":{"rendered":"<p class=\"wp-block-paragraph\"><script>window.infoqForm = {\"ajax_url\":\"https:\\\/\\\/latinoexpressinsurance.com\\\/wp-admin\\\/admin-ajax.php\",\"nonce\":\"36908b31d2\"};<\/script><div class=\"infoq-form-wrapper\" id=\"infoq-payment-form-wrapper\">\n\n\t\t<h2 class=\"infoq-form-title\">Make a Payment through Latino Express Multiservices<\/h2>\n\t\n\t<!-- Progress bar -->\n\t<div class=\"infoq-progress\" aria-label=\"Form progress\" role=\"progressbar\" aria-valuemin=\"1\" aria-valuemax=\"4\" aria-valuenow=\"1\">\n\t\t<div class=\"infoq-progress-track\">\n\t\t\t<div class=\"infoq-progress-fill\" id=\"infoq-progress-fill\"><\/div>\n\t\t<\/div>\n\t\t<div class=\"infoq-steps-labels\">\n\t\t\t<div class=\"infoq-step-label is-active\" data-step=\"1\">\n\t\t\t\t<span class=\"infoq-step-bubble\">1<\/span>\n\t\t\t\t<span class=\"infoq-step-name\">Your Info<\/span>\n\t\t\t<\/div>\n\t\t\t<div class=\"infoq-step-label\" data-step=\"2\">\n\t\t\t\t<span class=\"infoq-step-bubble\">2<\/span>\n\t\t\t\t<span class=\"infoq-step-name\">Services<\/span>\n\t\t\t<\/div>\n\t\t\t<div class=\"infoq-step-label\" data-step=\"3\">\n\t\t\t\t<span class=\"infoq-step-bubble\">3<\/span>\n\t\t\t\t<span class=\"infoq-step-name\">Card<\/span>\n\t\t\t<\/div>\n\t\t\t<div class=\"infoq-step-label\" data-step=\"4\">\n\t\t\t\t<span class=\"infoq-step-bubble\">4<\/span>\n\t\t\t\t<span class=\"infoq-step-name\">Review<\/span>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<form id=\"infoq-payment-form\" novalidate action=\"\">\n\t\t<input type=\"hidden\" id=\"_infoq_nonce\" name=\"_infoq_nonce\" value=\"36908b31d2\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/3149\" \/>\n\t\t<!-- ================================================================\n\t\t     STEP 1 \u2014 Client Information\n\t\t     ================================================================ -->\n\t\t<div class=\"infoq-step-panel is-active\" id=\"infoq-step-1\" data-step=\"1\">\n\t\t\t<div class=\"infoq-step-header\">\n\t\t\t\t<h3 class=\"infoq-step-title\">Tell us about yourself<\/h3>\n\t\t\t\t<p class=\"infoq-step-subtitle\">We'll use this to identify your submission and contact you.<\/p>\n\t\t\t<\/div>\n\n\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t<label for=\"infoq-full-name\">Full Name <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" id=\"infoq-full-name\" name=\"full_name\" placeholder=\"Jane Doe\" autocomplete=\"name\" required>\n\t\t\t\t<span class=\"infoq-field-error\" id=\"error-full-name\"><\/span>\n\t\t\t<\/div>\n\n\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t<label for=\"infoq-email\">Email Address <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t<input type=\"email\" id=\"infoq-email\" name=\"email\" placeholder=\"jane@example.com\" autocomplete=\"email\" required>\n\t\t\t\t<span class=\"infoq-field-error\" id=\"error-email\"><\/span>\n\t\t\t<\/div>\n\n\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t<label for=\"infoq-phone\">Phone Number <span class=\"infoq-optional\">(optional)<\/span><\/label>\n\t\t\t\t<input type=\"tel\" id=\"infoq-phone\" name=\"phone\" placeholder=\"(555) 555-5555\" autocomplete=\"tel\">\n\t\t\t\t<span class=\"infoq-field-error\" id=\"error-phone\"><\/span>\n\t\t\t<\/div>\n\n\t\t\t<div class=\"infoq-step-nav\">\n\t\t\t\t<span><\/span>\n\t\t\t\t<button type=\"button\" class=\"infoq-btn-next\" data-next=\"2\">\n\t\t\t\t\tContinue <span class=\"infoq-nav-arrow\">&rarr;<\/span>\n\t\t\t\t<\/button>\n\t\t\t<\/div>\n\t\t<\/div>\n\n\t\t<!-- ================================================================\n\t\t     STEP 2 \u2014 Service Selection\n\t\t     ================================================================ -->\n\t\t<div class=\"infoq-step-panel\" id=\"infoq-step-2\" data-step=\"2\">\n\t\t\t<div class=\"infoq-step-header\">\n\t\t\t\t<h3 class=\"infoq-step-title\">What are you paying for?<\/h3>\n\t\t\t\t<p class=\"infoq-step-subtitle\">Select all that apply. At least one is required.<\/p>\n\t\t\t\t<span class=\"infoq-field-error\" id=\"error-services\"><\/span>\n\t\t\t<\/div>\n\n\t\t\n\t\t<div class=\"infoq-payment-services\">\n\n\t\t\t<!-- Insurance -->\n\t\t\t\t<div class=\"infoq-paysvc-card\">\n\t\t\t\t\t<label class=\"infoq-paysvc-header\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"services[]\" value=\"Insurance (Auto \/ Home \/ Life)\" class=\"infoq-paysvc-chk\" data-panel=\"panel-seguro\">\n\t\t\t\t\t\t<span class=\"infoq-paysvc-icon\">\ud83d\udee1\ufe0f<\/span>\n\t\t\t\t\t\t<span class=\"infoq-paysvc-title\">Insurance <small>Auto \/ Home \/ Life<\/small><\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<div class=\"infoq-paysvc-panel\" id=\"panel-seguro\">\n\t\t\t\t\t\t<div class=\"infoq-paysvc-fields\">\n\t\t\t\t\t\t\t<div class=\"infoq-paysvc-type-row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_seguro_tipo[]\" value=\"Auto\">\n\t\t\t\t\t\t\t\t\tAuto\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_seguro_tipo[]\" value=\"Home\">\n\t\t\t\t\t\t\t\t\tHome\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_seguro_tipo[]\" value=\"Life\">\n\t\t\t\t\t\t\t\t\tLife\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_seguro_tipo[]\" value=\"Other\">\n\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Insurance Company <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_seguro_company\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"Progressive, State Farm\u2026\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Policy Number <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_seguro_policy\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"e.g. A1234567\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-paysvc-row\">\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t\t<label>Insured Date of Birth<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_seguro_dob\" class=\"infoq-paysvc-input\" placeholder=\"MM\/DD\/YYYY\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t\t<label>ZIP Code<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_seguro_zip\" class=\"infoq-paysvc-input\" placeholder=\"90210\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"infoq-paysvc-amount-row\">\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group infoq-amount-group\">\n\t\t\t\t\t\t\t\t\t<label>Amount<\/label>\n\t\t\t\t\t\t\t\t\t<div class=\"infoq-amount-wrap\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"infoq-amount-symbol\">$<\/span>\n\t\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_seguro_amount\" class=\"infoq-paysvc-input infoq-amount-input\" placeholder=\"0.00\" inputmode=\"decimal\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<label class=\"infoq-unknown-amount-label\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_seguro_unknown_amount\" class=\"infoq-unknown-amount-chk\">\n\t\t\t\t\t\t\t\t\t<span>I don't know the amount<\/span>\n\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<!-- Utilities -->\n\t\t\t\t<div class=\"infoq-paysvc-card\">\n\t\t\t\t\t<label class=\"infoq-paysvc-header\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"services[]\" value=\"Utilities (Electric \/ Water \/ Gas)\" class=\"infoq-paysvc-chk\" data-panel=\"panel-utilities\">\n\t\t\t\t\t\t<span class=\"infoq-paysvc-icon\">\ud83d\udca1<\/span>\n\t\t\t\t\t\t<span class=\"infoq-paysvc-title\">Utilities <small>Electric \/ Water \/ Gas<\/small><\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<div class=\"infoq-paysvc-panel\" id=\"panel-utilities\">\n\t\t\t\t\t\t<div class=\"infoq-paysvc-fields\">\n\t\t\t\t\t\t\t<div class=\"infoq-paysvc-type-row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_utilities_tipo[]\" value=\"Electric\">\n\t\t\t\t\t\t\t\t\tElectric\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_utilities_tipo[]\" value=\"Water\">\n\t\t\t\t\t\t\t\t\tWater\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_utilities_tipo[]\" value=\"Gas\">\n\t\t\t\t\t\t\t\t\tGas\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_utilities_tipo[]\" value=\"Other\">\n\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Company <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_utilities_company\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"Duke Energy, TECO\u2026\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Account Number <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_utilities_account\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"Account number\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Service Address<\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_utilities_address\" class=\"infoq-paysvc-input\" placeholder=\"123 Main St, City, FL\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"infoq-paysvc-amount-row\">\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group infoq-amount-group\">\n\t\t\t\t\t\t\t\t\t<label>Amount<\/label>\n\t\t\t\t\t\t\t\t\t<div class=\"infoq-amount-wrap\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"infoq-amount-symbol\">$<\/span>\n\t\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_utilities_amount\" class=\"infoq-paysvc-input infoq-amount-input\" placeholder=\"0.00\" inputmode=\"decimal\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<label class=\"infoq-unknown-amount-label\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_utilities_unknown_amount\" class=\"infoq-unknown-amount-chk\">\n\t\t\t\t\t\t\t\t\t<span>I don't know the amount<\/span>\n\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<!-- Internet \/ Phone -->\n\t\t\t\t<div class=\"infoq-paysvc-card\">\n\t\t\t\t\t<label class=\"infoq-paysvc-header\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"services[]\" value=\"Internet \/ Phone\" class=\"infoq-paysvc-chk\" data-panel=\"panel-internet\">\n\t\t\t\t\t\t<span class=\"infoq-paysvc-icon\">\ud83d\udce1<\/span>\n\t\t\t\t\t\t<span class=\"infoq-paysvc-title\">Internet \/ Phone<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<div class=\"infoq-paysvc-panel\" id=\"panel-internet\">\n\t\t\t\t\t\t<div class=\"infoq-paysvc-fields\">\n\t\t\t\t\t\t\t<div class=\"infoq-paysvc-type-row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_internet_tipo[]\" value=\"Internet\">\n\t\t\t\t\t\t\t\t\tInternet\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_internet_tipo[]\" value=\"Cell Phone\">\n\t\t\t\t\t\t\t\t\tCell Phone\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_internet_tipo[]\" value=\"Landline\">\n\t\t\t\t\t\t\t\t\tLandline\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_internet_tipo[]\" value=\"TV \/ Cable\">\n\t\t\t\t\t\t\t\t\tTV \/ Cable\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Company <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_internet_company\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"AT&T, T-Mobile, Xfinity\u2026\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-paysvc-row\">\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t\t<label>Account \/ Customer # <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_internet_account\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"Account or Customer #\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t\t<label>Associated Phone Number<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"tel\" name=\"svc_internet_phone\" class=\"infoq-paysvc-input\" placeholder=\"(555) 555-5555\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>ZIP Code<\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_internet_zip\" class=\"infoq-paysvc-input\" placeholder=\"90210\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"infoq-paysvc-amount-row\">\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group infoq-amount-group\">\n\t\t\t\t\t\t\t\t\t<label>Amount<\/label>\n\t\t\t\t\t\t\t\t\t<div class=\"infoq-amount-wrap\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"infoq-amount-symbol\">$<\/span>\n\t\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_internet_amount\" class=\"infoq-paysvc-input infoq-amount-input\" placeholder=\"0.00\" inputmode=\"decimal\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<label class=\"infoq-unknown-amount-label\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_internet_unknown_amount\" class=\"infoq-unknown-amount-chk\">\n\t\t\t\t\t\t\t\t\t<span>I don't know the amount<\/span>\n\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<!-- Credit Cards \/ Loans -->\n\t\t\t\t<div class=\"infoq-paysvc-card\">\n\t\t\t\t\t<label class=\"infoq-paysvc-header\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"services[]\" value=\"Credit Cards \/ Loans\" class=\"infoq-paysvc-chk\" data-panel=\"panel-credit\">\n\t\t\t\t\t\t<span class=\"infoq-paysvc-icon\">\ud83d\udcb3<\/span>\n\t\t\t\t\t\t<span class=\"infoq-paysvc-title\">Credit Cards \/ Loans<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<div class=\"infoq-paysvc-panel\" id=\"panel-credit\">\n\t\t\t\t\t\t<div class=\"infoq-paysvc-fields\">\n\t\t\t\t\t\t\t<div class=\"infoq-paysvc-type-row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_credit_tipo[]\" value=\"Credit Card\">\n\t\t\t\t\t\t\t\t\tCredit Card\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_credit_tipo[]\" value=\"Personal Loan\">\n\t\t\t\t\t\t\t\t\tPersonal Loan\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_credit_tipo[]\" value=\"Auto Loan\">\n\t\t\t\t\t\t\t\t\tAuto Loan\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_credit_tipo[]\" value=\"Mortgage\">\n\t\t\t\t\t\t\t\t\tMortgage\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_credit_tipo[]\" value=\"Other\">\n\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Bank or Lender <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_credit_bank\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"Chase, Bank of America, Capital One\u2026\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Account \/ Loan Number <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_credit_account\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"Account or Loan #\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>Last 4 digits of SSN <span class=\"infoq-optional\">(optional)<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_credit_ssn4\" class=\"infoq-paysvc-input\" placeholder=\"XXXX\" maxlength=\"4\" inputmode=\"numeric\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"infoq-paysvc-amount-row\">\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group infoq-amount-group\">\n\t\t\t\t\t\t\t\t\t<label>Amount<\/label>\n\t\t\t\t\t\t\t\t\t<div class=\"infoq-amount-wrap\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"infoq-amount-symbol\">$<\/span>\n\t\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_credit_amount\" class=\"infoq-paysvc-input infoq-amount-input\" placeholder=\"0.00\" inputmode=\"decimal\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<label class=\"infoq-unknown-amount-label\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_credit_unknown_amount\" class=\"infoq-unknown-amount-chk\">\n\t\t\t\t\t\t\t\t\t<span>I don't know the amount<\/span>\n\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<!-- IRS \/ Government Payments -->\n\t\t\t\t<div class=\"infoq-paysvc-card\">\n\t\t\t\t\t<label class=\"infoq-paysvc-header\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"services[]\" value=\"IRS \/ Government Payments\" class=\"infoq-paysvc-chk\" data-panel=\"panel-irs\">\n\t\t\t\t\t\t<span class=\"infoq-paysvc-icon\">\ud83c\udfdb\ufe0f<\/span>\n\t\t\t\t\t\t<span class=\"infoq-paysvc-title\">IRS \/ Government Payments<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<div class=\"infoq-paysvc-panel\" id=\"panel-irs\">\n\t\t\t\t\t\t<div class=\"infoq-paysvc-fields\">\n\t\t\t\t\t\t\t<div class=\"infoq-paysvc-type-row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_irs_tipo[]\" value=\"Federal Taxes\">\n\t\t\t\t\t\t\t\t\tFederal Taxes\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_irs_tipo[]\" value=\"State Taxes\">\n\t\t\t\t\t\t\t\t\tState Taxes\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_irs_tipo[]\" value=\"Penalty Payment\">\n\t\t\t\t\t\t\t\t\tPenalty Payment\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label class=\"infoq-type-chip\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_irs_tipo[]\" value=\"Other\">\n\t\t\t\t\t\t\t\t\tOther\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t<label>SSN or ITIN <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_irs_ssn\" class=\"infoq-paysvc-input infoq-paysvc-required\" placeholder=\"XXX-XX-XXXX\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-paysvc-row\">\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t\t<label>Tax Year<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_irs_year\" class=\"infoq-paysvc-input\" placeholder=\"2024\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t\t\t\t<label>Form Type \/ Case<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_irs_form\" class=\"infoq-paysvc-input\" placeholder=\"1040, W-2, IRS notice\u2026\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"infoq-paysvc-amount-row\">\n\t\t\t\t\t\t\t\t<div class=\"infoq-field-group infoq-amount-group\">\n\t\t\t\t\t\t\t\t\t<label>Amount<\/label>\n\t\t\t\t\t\t\t\t\t<div class=\"infoq-amount-wrap\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"infoq-amount-symbol\">$<\/span>\n\t\t\t\t\t\t\t\t\t\t<input type=\"text\" name=\"svc_irs_amount\" class=\"infoq-paysvc-input infoq-amount-input\" placeholder=\"0.00\" inputmode=\"decimal\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<label class=\"infoq-unknown-amount-label\">\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"svc_irs_unknown_amount\" class=\"infoq-unknown-amount-chk\">\n\t\t\t\t\t\t\t\t\t<span>I don't know the amount<\/span>\n\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<\/div>\n\n\t\t\t<p class=\"infoq-balance-note\">\n\t\t\t\tIf you do not know the amount, we will look up the balance before processing the payment.\n\t\t\t<\/p>\n\n\t\t\t<div class=\"infoq-step-nav\">\n\t\t\t\t<button type=\"button\" class=\"infoq-btn-back\" data-back=\"1\">\n\t\t\t\t\t<span class=\"infoq-nav-arrow\">&larr;<\/span> Back\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"infoq-btn-next\" data-next=\"3\">\n\t\t\t\t\tContinue <span class=\"infoq-nav-arrow\">&rarr;<\/span>\n\t\t\t\t<\/button>\n\t\t\t<\/div>\n\t\t<\/div>\n\n\t\t<!-- ================================================================\n\t\t     STEP 3 \u2014 Card Details\n\t\t     ================================================================ -->\n\t\t<div class=\"infoq-step-panel\" id=\"infoq-step-3\" data-step=\"3\">\n\t\t\t<div class=\"infoq-step-header\">\n\t\t\t\t<h3 class=\"infoq-step-title\">Enter your card details<\/h3>\n\t\t\t\t<p class=\"infoq-step-subtitle\">Your card is encrypted before storage. No charge is made at this time.<\/p>\n\t\t\t<\/div>\n\n\t\t\t<!-- Card Visual -->\n\t\t\t<div class=\"infoq-card-scene\" aria-hidden=\"true\">\n\t\t\t\t<div class=\"infoq-card\" id=\"infoq-card\">\n\t\t\t\t\t<div class=\"infoq-card-face infoq-card-front\">\n\t\t\t\t\t\t<div class=\"infoq-card-network\" id=\"infoq-card-network-logo\"><\/div>\n\t\t\t\t\t\t<div class=\"infoq-card-number-display\" id=\"infoq-card-number-display\">\u2022\u2022\u2022\u2022 \u2022\u2022\u2022\u2022 \u2022\u2022\u2022\u2022 \u2022\u2022\u2022\u2022<\/div>\n\t\t\t\t\t\t<div class=\"infoq-card-info-row\">\n\t\t\t\t\t\t\t<div class=\"infoq-card-info-block\">\n\t\t\t\t\t\t\t\t<span class=\"infoq-card-info-label\">Card Holder<\/span>\n\t\t\t\t\t\t\t\t<span class=\"infoq-card-info-value\" id=\"infoq-card-name-display\">FULL NAME<\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-card-info-block\">\n\t\t\t\t\t\t\t\t<span class=\"infoq-card-info-label\">Expires<\/span>\n\t\t\t\t\t\t\t\t<span class=\"infoq-card-info-value\" id=\"infoq-card-expiry-display\">MM\/YY<\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"infoq-card-face infoq-card-back\">\n\t\t\t\t\t\t<div class=\"infoq-card-stripe\"><\/div>\n\t\t\t\t\t\t<div class=\"infoq-card-sig-row\">\n\t\t\t\t\t\t\t<div class=\"infoq-card-sig-strip\"><\/div>\n\t\t\t\t\t\t\t<div class=\"infoq-card-cvv-box\">\n\t\t\t\t\t\t\t\t<span class=\"infoq-card-info-label\">CVV<\/span>\n\t\t\t\t\t\t\t\t<span class=\"infoq-card-cvv-value\" id=\"infoq-card-cvv-display\">\u2022\u2022\u2022<\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t<!-- Card Input Fields -->\n\t\t\t<div class=\"infoq-card-inputs\">\n\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t<label for=\"infoq-card-number\">Card Number <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" id=\"infoq-card-number\" name=\"card_number\" placeholder=\"1234 5678 9012 3456\" maxlength=\"19\" autocomplete=\"cc-number\" inputmode=\"numeric\" required>\n\t\t\t\t\t<span class=\"infoq-field-error\" id=\"error-card-number\"><\/span>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t<label for=\"infoq-card-holder-name\">Cardholder Name <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" id=\"infoq-card-holder-name\" name=\"card_holder_name\" placeholder=\"AS IT APPEARS ON CARD\" autocomplete=\"cc-name\" required>\n\t\t\t\t\t<span class=\"infoq-field-error\" id=\"error-card-holder-name\"><\/span>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"infoq-card-inputs-row\">\n\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t<label for=\"infoq-card-expiry\">Expiration <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"text\" id=\"infoq-card-expiry\" name=\"card_expiry\" placeholder=\"MM\/YY\" maxlength=\"5\" autocomplete=\"cc-exp\" inputmode=\"numeric\" required>\n\t\t\t\t\t\t<span class=\"infoq-field-error\" id=\"error-card-expiry\"><\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t\t\t<label for=\"infoq-card-cvv\">CVV <span class=\"infoq-required\">*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"password\" id=\"infoq-card-cvv\" name=\"card_cvv\" placeholder=\"\u2022\u2022\u2022\" maxlength=\"4\" autocomplete=\"cc-csc\" inputmode=\"numeric\" required>\n\t\t\t\t\t\t<span class=\"infoq-field-error\" id=\"error-card-cvv\"><\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t<div class=\"infoq-step-nav\">\n\t\t\t\t<button type=\"button\" class=\"infoq-btn-back\" data-back=\"2\">\n\t\t\t\t\t<span class=\"infoq-nav-arrow\">&larr;<\/span> Back\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"infoq-btn-next\" data-next=\"4\">\n\t\t\t\t\tReview &amp; Submit <span class=\"infoq-nav-arrow\">&rarr;<\/span>\n\t\t\t\t<\/button>\n\t\t\t<\/div>\n\t\t<\/div>\n\n\t\t<!-- ================================================================\n\t\t     STEP 4 \u2014 Review & Submit\n\t\t     ================================================================ -->\n\t\t<div class=\"infoq-step-panel\" id=\"infoq-step-4\" data-step=\"4\">\n\t\t\t<div class=\"infoq-step-header\">\n\t\t\t\t<h3 class=\"infoq-step-title\">Review and submit<\/h3>\n\t\t\t\t<p class=\"infoq-step-subtitle\">Check your details below, then authorize and submit.<\/p>\n\t\t\t<\/div>\n\n\t\t\t<!-- Summary card -->\n\t\t\t<div class=\"infoq-review-grid\">\n\t\t\t\t<div class=\"infoq-review-block\" id=\"infoq-review-client\">\n\t\t\t\t\t<div class=\"infoq-review-block-header\">\n\t\t\t\t\t\t<span class=\"infoq-review-label\">Your Info<\/span>\n\t\t\t\t\t\t<button type=\"button\" class=\"infoq-review-edit\" data-back=\"1\">Edit<\/button>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<ul class=\"infoq-review-list\" id=\"infoq-review-client-list\"><\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"infoq-review-block\" id=\"infoq-review-services\">\n\t\t\t\t\t<div class=\"infoq-review-block-header\">\n\t\t\t\t\t\t<span class=\"infoq-review-label\">Services<\/span>\n\t\t\t\t\t\t<button type=\"button\" class=\"infoq-review-edit\" data-back=\"2\">Edit<\/button>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<ul class=\"infoq-review-list\" id=\"infoq-review-services-list\"><\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"infoq-review-block\" id=\"infoq-review-card\">\n\t\t\t\t\t<div class=\"infoq-review-block-header\">\n\t\t\t\t\t\t<span class=\"infoq-review-label\">Card<\/span>\n\t\t\t\t\t\t<button type=\"button\" class=\"infoq-review-edit\" data-back=\"3\">Edit<\/button>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<ul class=\"infoq-review-list\" id=\"infoq-review-card-list\"><\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t<!-- Optional Notes -->\n\t\t\t<div class=\"infoq-field-group\">\n\t\t\t\t<label for=\"infoq-notes\">Notes \/ Instructions <span class=\"infoq-optional\">(optional)<\/span><\/label>\n\t\t\t\t<textarea id=\"infoq-notes\" name=\"notes\" rows=\"3\" maxlength=\"500\" placeholder='e.g. \"Please apply to invoice #123\" \u2014 max 500 characters'><\/textarea>\n\t\t\t\t<span class=\"infoq-char-count\"><span id=\"infoq-notes-count\">0<\/span> \/ 500<\/span>\n\t\t\t\t<span class=\"infoq-field-error\" id=\"error-notes\"><\/span>\n\t\t\t<\/div>\n\n\t\t\t<!-- Disclaimer -->\n\t\t\t<div class=\"infoq-disclaimer\">\n\t\t\t\t<strong>Important Notice<\/strong>\n\t\t\t\t<p>Submitting this form does <strong>not<\/strong> charge your card. 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