Payment Plus Form

This program is for Domestic Companies only.

To enroll in Payment Plus, virtual credit card program, please have an authorized company representative complete the below fillable form fields. If you have any questions you can contact us at paymentplus@finance.ucla.edu.

Contact:

Company Name

Contact Name and Title

Remittance Email (Receivable Department or designated person to process card transaction payments)

Phone

Remittance Street Address

City/Town

State/Province

ZIP/Postal Code

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