ACH Debit Note: With the exception of cash flow applications 2 Yes accepting ACH Credit, Treasury requires Forms cash flow applications to accept ACH Debit due to the low cost of payment processing. ACH Credit If selected, NO other payment type will be accepted for your Forms cash flow application. You must complete the ACH Credit collections section 3 (4.2). Note: You will receive a credit gateway account number. Please keep this number for your records. Plastic Card (Yes/No) Note: Includes both credit and debit cards. In cases of 4 Debt collection, ONLY debit cards will be accepted. Digital Wallet Current providers: PayPal/Amazon Pay Note: In cases of Debt collection, PayPal is the only 5 Yes available Digital Wallet provider. When using PayPal, only associated bank accounts or PayPal accounts already containing money will be used to fund the payment. Form Details 6 Form Name (Max. 80 alphanumeric characters) Form Description – optional (To appear on “Before 7 You Begin” page. Max. 255 alphanumeric characters. Example: “Use this form to pay your Excise Tax.”) Form Instructions (Optional, formatted text to appear 8 on “Before You Begin” page; max. 4,000 characters. You may also provide this with your form sample.) Payment Confirmation Instructions Language to appear above the transaction details on Default: the customer’s payment confirmation email. “Your payment has been submitted to Pay.gov and the details are below. If you have any questions Note: Contact information in the default message is 9 regarding this payment, please contact CONTACT automatically populated from information you NAME at PHONE NUMBER or EMAIL ADDRESS.” provide in section 6.1.7. If you replace the default language shown, be sure to include contact information. OMB Form Number (If applicable; max. 20 10 alphanumeric characters) Agency Form Control Number 11 (Short name for the form to appear in search results; max. 20 alphanumeric characters; e.g. VA Copay)
2 ACH Debit Note: With the exception of cash flow applications accepting ACH Credit, Treasury requires Forms cash flow applications to accept ACH Debit due to the low cost of payment processing. Yes 3 ACH Credit If selected, NO other payment type will be accepted for your Forms cash flow application. You must complete the ACH Credit collections section (4.2). Note: You will receive a credit gateway account number. Please keep this number for your records. 4 Plastic Card (Yes/No) Note: Includes both credit and debit cards. In cases of Debt collection, ONLY debit cards will be accepted. 5 Digital Wallet Current providers: PayPal/Amazon Pay Note: In cases of Debt collection, PayPal is the only available Digital Wallet provider. When using PayPal, only associated bank accounts or PayPal accounts already containing money will be used to fund the payment. Yes Form Details 6 Form Name (Max. 80 alphanumeric characters) 7 Form Description – optional (To appear on “Before You Begin” page. Max. 255 alphanumeric characters. Example: “Use this form to pay your Excise Tax.”) 8 Form Instructions (Optional, formatted text to appear on “Before You Begin” page; max. 4,000 characters. You may also provide this with your form sample.) 9 Payment Confirmation Instructions Language to appear above the transaction details on the customer’s payment confirmation email. Note: Contact information in the default message is automatically populated from information you provide in section 6.1.7. If you replace the default language shown, be sure to include contact information. Default: “Your payment has been submitted to Pay.gov and the details are below. If you have any questions regarding this payment, please contact CONTACT NAME at PHONE NUMBER or EMAIL ADDRESS.” 10 OMB Form Number (If applicable; max. 20 alphanumeric characters) 11 Agency Form Control Number (Short name for the form to appear in search results; max. 20 alphanumeric characters; e.g. VA Copay)
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