Payment Form template

Complete your payment details below.

Financial template · 10 fields (7 required) · ~2 min for respondents to complete · Free plan · No credit card · Fully customizable

Set up your payment form

Complete your payment details below.

Use this to record what the customer is paying for. To take payment on the form, connect Stripe and add a Payment field in the editor; never ask for card details in regular fields.

The form separates phone number, billing address, what is this payment for?, invoice or reference number (optional) into labeled questions. Review the choices and required fields for your organization before sharing it.

Best practices

• Use this to record what the customer is paying for. To take payment on the form, connect Stripe and add a Payment field in the editor; never ask for card details in regular fields.
• Customize the phone number and billing address questions to match your records and terminology.
• Name the team that reviews responses and explain what happens after submission. A requested date, service or approval is not automatically confirmed.
• Ask only for information needed for this step. Arrange any sensitive supporting documents through an appropriate private process.

Every field, explained

• Payer full name (Name, required)
• Email for receipt (Email, required)
• Phone number (Phone)
• Billing address (Address, required)
• What is this payment for? (Dropdown, required)
• Invoice or reference number (optional) (Short text)
• Payment amount (USD) (Number, required) — Enter numbers only, for example 250.00.
• Payment type (Single choice, required)
• Notes (optional) (Long text)
• Confirmation (Multiple choice, required)

Frequently asked questions

What does this payment form template collect?

Alongside contact details, it asks for phone number, billing address, what is this payment for?, invoice or reference number (optional), payment amount (usd), payment type, notes (optional), confirmation. You can rename questions, change choices and remove fields that your workflow does not need.

How should I use this payment form form?

Use this to record what the customer is paying for. To take payment on the form, connect Stripe and add a Payment field in the editor; never ask for card details in regular fields.

Can I edit this form and print a copy?

Yes. Open an editable draft, adjust the questions, and review the preview before publishing. You can also use the template page’s print option. Publishing requires an account; the draft can be tried first.

Related templates

• Payment Receipt — 12 fields
• Bill Payment Form — 11 fields
• PayPal Order Form — 11 fields

Customize this form — opens an editable draft, no account needed — — or browse all 836 templates.