Make A Payment We Accept:
Make Check or Money Order (Domestic Only) Payable to: "D.B. Kosie & Associates" * Denotes Required Field
Name / Email / CC Info.
* Name on Credit Card: The name on the credit card is required. * Email Address: An email address is required for receipt of payment.This is not a valid email address.
* Credit Card Number: A valid credit card number is required.The credit card number you entered is not valid.
* Expiration Date (MMYY ex. 0112): The expiration date on the credit card is required. Please enter the date as MMYY ex: 0112.Please enter the date as MMYY ex 0112.Please enter the date as MMYY ex: 0112.
* Card Verification Value ( 3 digit CVV code on back of card): A valid CVV code is require.A valid CVV code is required.The CVV code is 3 numbers on the back of the card (furthest to the right).The CVV code is 3 numbers on the back of the card (furthest to the right).
Payment Amount Info.
* Total Amount Due A valid dollar amount is required.A valid dollar amount is required. * Amount Being Paid A valid dollar amount is required.A valid dollar amount is required.
Survey Info. * Survey For: Name/Address/Info. Survey informtion is required.
Questions / Comments
-Type your questions or comments here: -Please allow 24 hours for processing
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* Please Type In The Security Number Above: A valid security number is required.A valid security number is required.The number entered is less than the minimum required.The number entered is greater than the maximum allowed.