COPPERSMITH / PAYMENT CENTER

IN THE EVENT YOUR CREDIT CARD IS DECLINED,
DO NOT RETRY YOUR CARD. PLEASE CONTACT YOUR COPPERSMITH AGENT.

* Indicates a required field

*	Account Number:
*	Reference or Airway Bill Number:		*Amount:	Invalid Amount
	Reference or Airway Bill Number:		Amount:	Invalid Amount
	Reference or Airway Bill Number:		Amount:	Invalid Amount
	Reference or Airway Bill Number:		Amount:	Invalid Amount
	Reference or Airway Bill Number:		Amount:	Invalid Amount