Continuing Maintenance Payment

Please note. Red Dirt Septic accepts Visa, Mastercard and Discover card. We do NOT provide payment via AMEX. When services are rendered and payment is due, AMEX will not process and an alternate form of payment will be required.

Name*
First Last
Email Address*
Phone
Address*
Street Address City State ZIP Code
Start Date Of Service (Actual Day of Service May Vary)*
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Continuing Maintenance Fee (bi-annual)*
Price:
Credit Card Number*
Exp Month*
Exp Year*