Skip to main content

Supply a Credit Card

A number of services require that Parkway Digital supply a credit card for payment or verification purposes. Please complete the below secure form to provide us with the card you would like used for this purpose.

Send Credit Card to Parkway

"*" indicates required fields

Submit your credit card information to Parkway Digital by completing the form and then clicking the “Send Credit Card to Parkway” button.

Don’t want to provide you credit card online? Call Parkway at 716-633-4097.

Your Information

The First Name of the person filling out this form.
The Last Name of the person filling out this form.
Your email address. This is where Parkway Digital can reach you directly, if needed.
A phone number where you can be reached if there are any issues with the card.

Site Information

(a.k.a. "GMA") Please provide if available.

Credit Card (CC) Information

The full name as printed on the credit card.
Credit card number
The credit card expiration date.
The credit card security code, also known as the CVV. For Visa/Mastercard, the three-digit CVV number is printed on the signature panel on the back of the card immediately after the card's account number. For American Express, the four-digit CVV number is printed on the front of the card above the card account number.

Credit Card Billing Information

The billing information associated with the credit card at the issuing bank or financial institution.

The phone number associated with the credit card.

Additional Information

Comments and/or additional information.
Permission*
This field is for validation purposes and should be left unchanged.