Payment Center Gateway - Design Theory

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Installment Options

We are happy to announce that we’ve partnered with our processing company Square, and are able to offer Installment options. To learn more, click here.

"*" indicates required fields

Name on the Payment Card*

First Last

Business Name*

Your Website

Phone

Billing Address for the Card*

Name on Card Street Address City State ZIP Code

(same as the credit/debit card)

Authorization Statement

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Credit Card Number*

Card Expiration Date*

CCID*

The three or four digits on the back of your card

Card Type*

Visa

Mastercard

American Express

Discover

YES I AUTHORIZE

By submitting this form you authorize Design Theory LLC to use the above credit/debit card information to tender products or services rendered by you.