DFY Diversify
(619) 616-2884
Atlanta, GA

DFY Diversify

Billing Information:

Company Name:
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Country:
Phone Number:
Email Address:
Notes:

Account Holder Name:
Bank Routing Number:
Bank Account Number:
Bank Account Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date:
Card ID (CVV2/CID) Number:

Amount (Max $10,000): $

Cash Adj. Fee (Credit Card Cost): $Convenience Fee: $

Total Amount: $

This is a One-Time transaction with the Payment Effective Date of 11/03/25.
By clicking Process Payment Button below you are authorizing this ACH transaction.
By authorizing this transaction customer agrees that company named above may convert this transaction into an Electronic Funds Transfer (EFT) transaction to send via ACH debit to the bank account for the amount indicated above.
To revoke this authorization contact Customer Support at within 48 hours prior to the Payment Effective Date.
Processing times may not allow for revocation of this authorization.
Additionally, in the event this ACH is returned unpaid, a service fee in the amount of up to the maximum allowable by law will be charged to the bank account indicated via ACH.

By checking this box and clicking 'Process Payment',
I agree to pay the above amount listed.