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American Legion Auxiliary

Secure Payment Form

   
Date
Amount
Surcharge Fee (2.91%)
Total Amount
Number of Registrations

List Senior and Juniors

Number of Book of Reports

How many Book of Reports are you paying for and who should they be given too (If more than 1 person registering)?

Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Unit #
First Name
Last Name
Address
Address 2
City
State
Zip
Phone Number
Email Address