FMG America - Payment

Name on Card :

Visa/Mastercard/Amex :

Card Number :

Card Expiration Date :

CVV Security Code :

Total Charge Amount :

Card Billing Address :

Client's Social Security # :

Client's Name :

Email :

Phone :

Service Purchased :

Medical Specialties:

Payment

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Secure payments using your major
credit card or for PAYPAL, click
the link above.

Please fill out the entire form below
for a valid receipt if you do choose
to pay directly via credit card.

Payment Via PAYPAL

Click the PAYPAL icon above to pay using your credit card. Or contact us at
payment@fmgamerica.com for other options.

-Use information@fmgamerica.com as the recipient's email for your PAYPAL payment email.

-PAYPAL's E-Commerce solutions are simple, private, and provide our clients with an alternate
secure payment option. Each payment creates a binding and traceable receipt of the transaction
for your records.

-Any questions or problems regarding PAYPAL, please contact their customer service directly at:
1-888-221-1161

-For all other payment and billing issues please contact payment@fmgamerica.com .

We ensure U.S. medical placement for all qualified candidates.

Due to our fees associated with credit card processing, you may also be eligible for a
discounted fee (up to $100 off) if you pay with a money order or bank check. For
more information email payment@fmgamerica.com .