Online Payments : Resources : Newfax Corporation

333 West Woodruff

Toledo, OH 43604

Phone 419-241-5157

Fax 419-241-2018

E-mail

Full Name

First Name *

Last Name *

Company Name (Required)

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Phone Number (Required)

Email Address (Required)

Purchase Order # (Required)

If none put N/A

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Invoice #

Amount (Required)

Please use dollar and cents ex: (25.59)

Product/Service Description (Required)

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged