Cocoa Village Publishing


Single Payment Through Gateway

To do a ONE time payment throuth our QuantumGateway link by Check Payments (EFT) and Credit Card payments (CC) or you may call us over the phone.

Please enter comments or details when processing so that after we receive notice from the processing service we can associate the payment with you and your service. If you don't already have an service with us nor bill/invoice, contact us before using.

This form is to create a ONE time single payment with your checking account (EFT) or Discover-MC-Visa card (CC) through our processor. Enter comment to associate your payment with your service. If prefer to do by phone or questions - call/text (321)252-8133. (If later you want us to setup recurring transactions it may be possible with same information and additional authorization - Call)

Amount Paid:




A reminder, we recommend that you have arrangements with us prior to using the processing links on this page. These links are here for convenience and are outside the typical shopping/invoice system. We may have sent this reference page for single payment in an email for an existing situation.

Facsimile Information for Electronic Funds Transfer

For payments by EFT (checks) after you go through all the processing please send/fax the following (because doing e-Checks can be more fraught with chargebacks). We believe it is very important to avoid improper charges and the associated fees. If your account has wrong charges, let us know asap, call us direct to resolve. To help processing checks by facsimille please send the following information and if feasible a voided check also. Please have any check used for example marked VOID. Scan and send by email or snail mail:

I authorize Cocoa Village Publishing to initiate either an electronic debit or to create and process a demand draft against my bank account on or after ________________ for the amount of _________. I acknowledge that the origination of ACH transactions to my account must comply with the provisioning of United States law. My account information is as follows: 
Bank Information
Bank ABA Number:
Bank Account Number: 
Bank Account Type: [Checking/Savings/Business Checking]
Customer Signature:
Customer Printed Name:
Date Signed: