One-Time Payment Authorization Form Instructions
CONCEPTUAL MINDWORKS, INC. DBA SEVOCITY® / 13409 NW Military HWY, Suite 201 / San Antonio, TX 78231
P 877-777-2298 / P 210-737-0777 / F 210-737-6677 / E finance@sevocity.com

These items MUST be completed entirely in this order in order for the form to
generate the FINISH button.

  1. Complete Date field first – This should be the effective date to apply this payment
  2. Complete Sevocity Account Name – this should be the name of your Practice or
  3. (Existing Customers Only) Complete Billing ID, i.e. SEVxxxx.
  4. Choose Account Type by clicking inside the appropriate button. A Type MUST be
    chosen before payment fields will be active.
  5. Inside the appropriate Payment Type box, a payment form (Checking or Savings,
    VISA, MasterCard, AMEX) button MUST BE chosen to enter the data.
  6. Complete information is required in each field.
  7. Enter complete information in all remaining fields to activate the FINISH button in
    lower right hand corner.
  8. Click on the FINISH button to send completed form to Sevocity Finance.