Make A PaymentAll charges are subject to a 3% transaction fee. 1Payee Info2Credit Card Info * = RequiredCHOOSE YOUR PAYEE TYPEPRIME Payees* Currently Driving for PRIME Not Currently Driving for PRIME In-House Associate Prepaid Customer EcoShred Claims Success Leasing Donations This field is hidden when viewing the formCurrently Driving for PRIMECurrently Driving for PRIME Payment For* Insurance Negative Balance Other Currently Driving for PRIME Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to Current Driver payment amount Price: $0.00 Driver Name* First Last Driver Phone*Please enter a valid phone numberDriver Email* Please enter a valid email addressCurrently Driving for PRIME: Driver Code*This field is hidden when viewing the formNot Currently Driving for PRIMENot Currently Driving for PRIME Payment For* Insurance Negative Balance Not Currently Driving for PRIME Payment Amount* Not Current Driver Name* First Last Not Current Driver Phone*Please enter a valid phone numberNot Current Driver Email* Please enter a valid email addressNot Current Driver Code*This field is hidden when viewing the formIn-House AssociatePRIME Associate payment for:* Insurance Other PRIME Associate Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to PRIME Associate payment amount Price: $0.00 PRIME Associate Name* First Last PRIME Associate Phone*Please enter a valid phone numberPRIME Associate Email* Please enter a valid email addressIn-House Code*This field is hidden when viewing the formPrepaid CustomerPrepaid Customer Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to Prepaid Customer payment amount Price: $0.00 Prepaid Customer Name* First Last Prepaid Customer Phone*Please enter a valid phone numberPrepaid Customer Email* Please enter a valid email addressCustomer Code*This field is hidden when viewing the formEcoShredEcoShred Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to EcoShred payment amount Price: $0.00 EcoShred Customer Name* First Last EcoShred Customer Phone*Please enter a valid phone numberEcoShred Customer Email* Please enter a valid email addressEcoShred Customer Invoice #*This field is hidden when viewing the formClaimsClaims Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to Claims payment amount Price: $0.00 Claims Customer Name* First Last Claims Customer Phone*Please enter a valid phone number.Claims Customer Email* Please enter a valid email address.Claim #*This field is hidden when viewing the formSuccess LeasingSuccess Leasing Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to Success Leasing payment amount Price: $0.00 Success Leasing Customer Name* First Last Success Leasing Customer Phone*Please enter a valid phone number.Success Leasing Customer Email* Please enter a valid email address.Success Leasing Truck #*This field is hidden when viewing the formDonationsDescription*Donation Amount* All charges are subject to a 3% transaction fee.Associate Name* First Last Associate Email* In-house / Driver Code*This field is hidden when viewing the formCalculated Payment AmountTotal Payment Amount Payment amount + 3% transaction feeTotal Payment Amount Total Payment Amount Payment amount + 3% transaction feeTotal Payment Amount This field is hidden when viewing the formCredit Card InfoCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name Billing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Prime Inc.2740 North Mayfair Springfield, MO 65803Drive for PrimeMake A PaymentAll charges are subject to a 3% transaction fee. 1Payee Info2Credit Card Info * = RequiredCHOOSE YOUR PAYEE TYPEPRIME Payees* Currently Driving for PRIME Not Currently Driving for PRIME In-House Associate Prepaid Customer EcoShred Claims Success Leasing Donations This field is hidden when viewing the formCurrently Driving for PRIMECurrently Driving for PRIME Payment For* Insurance Negative Balance Other Currently Driving for PRIME Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to Current Driver payment amount Price: $0.00 Driver Name* First Last Driver Phone*Please enter a valid phone numberDriver Email* Please enter a valid email addressCurrently Driving for PRIME: Driver Code*This field is hidden when viewing the formNot Currently Driving for PRIMENot Currently Driving for PRIME Payment For* Insurance Negative Balance Not Currently Driving for PRIME Payment Amount* Not Current Driver Name* First Last Not Current Driver Phone*Please enter a valid phone numberNot Current Driver Email* Please enter a valid email addressNot Current Driver Code*This field is hidden when viewing the formIn-House AssociatePRIME Associate payment for:* Insurance Other PRIME Associate Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to PRIME Associate payment amount Price: $0.00 PRIME Associate Name* First Last PRIME Associate Phone*Please enter a valid phone numberPRIME Associate Email* Please enter a valid email addressIn-House Code*This field is hidden when viewing the formPrepaid CustomerPrepaid Customer Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to Prepaid Customer payment amount Price: $0.00 Prepaid Customer Name* First Last Prepaid Customer Phone*Please enter a valid phone numberPrepaid Customer Email* Please enter a valid email addressCustomer Code*This field is hidden when viewing the formEcoShredEcoShred Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to EcoShred payment amount Price: $0.00 EcoShred Customer Name* First Last EcoShred Customer Phone*Please enter a valid phone numberEcoShred Customer Email* Please enter a valid email addressEcoShred Customer Invoice #*This field is hidden when viewing the formClaimsClaims Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to Claims payment amount Price: $0.00 Claims Customer Name* First Last Claims Customer Phone*Please enter a valid phone number.Claims Customer Email* Please enter a valid email address.Claim #*This field is hidden when viewing the formSuccess LeasingSuccess Leasing Payment Amount* All charges are subject to a 3% transaction fee.Add 3% to Success Leasing payment amount Price: $0.00 Success Leasing Customer Name* First Last Success Leasing Customer Phone*Please enter a valid phone number.Success Leasing Customer Email* Please enter a valid email address.Success Leasing Truck #*This field is hidden when viewing the formDonationsDescription*Donation Amount* All charges are subject to a 3% transaction fee.Associate Name* First Last Associate Email* In-house / Driver Code*This field is hidden when viewing the formCalculated Payment AmountTotal Payment Amount Payment amount + 3% transaction feeTotal Payment Amount Total Payment Amount Payment amount + 3% transaction feeTotal Payment Amount This field is hidden when viewing the formCredit Card InfoCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name Billing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Prime Inc.2740 North Mayfair Springfield, MO 65803Drive for Prime
