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.

Name*
First Last
Business Name
Billing Address*
Street Address Address Line 2 City State ZIP Code

(same as the credit/debit card)
Your Website
Email
Phone
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*
Card Type*
- Visa
- Mastercard
- American Express
- Discover
CCID*

The three or four digits on the back of your card
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.

Installment Options

Authorization Statement

YES I AUTHORIZE