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American Legion Auxiliary

Secure Payment Form

   
Order Date
Amount
# of Seniors
# of Juniors
Comments
<p>&lt;p&gt;Enter if you are using any credits here.&lt;/p&gt;</p>
Name as on Check
Bank Routing Number
Bank Account Number
Unit Name
First Name
Last Name
Address
Address 2
City
State
Zip
Country
Phone Number
Email Address