Credit Card Form
3%  charge with each transaction. 

Download

We do not accept payments over the phone! We need a signature to process your payment. 

This form can be sent multiple ways:

Mail: PO Box 157, Eagle Point ,OR

Email: epidist@centurylink.net

Fax: 541-826-8738

Do you have a smart phone?
​If so ,you can fill out the form and send a picture  to our email : ​epidist@centurylink.net

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Smart Phone help:

- Click Download

- Take a screen shot (press home button & silent button)

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