PayDollar Payment Service Generic Payment Page

	Fields with are required and please fill out the form in English.*
	*Recipient Merchant ID :** (Please consult your merchant for the Merchant ID)
	Merchant Reference No.:
	Payment Access Code : (Keep empty if not provided by your merchant)
	*Amount :**
	*Your Name :**
	*Your Email :**
	Remarks : (Max. 100 characters)
	*Verification Code :**