IPC Educational and Welfare Society of North America
Secure Payment Form
Payment Summary:
Payment Date:
04/25/24
Payment Amount:
Order Number:
Customer IP:
3.145.186.6
Payment Purpose:
COTS
Charity Donation
Society Membership
Student Scholarship
Summer Internship
Capital Project
Other
Credit Card Information:
Card Type:
Visa
MasterCard
American Express
Discover
Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date:
MMYY
Card ID (CVV2/CID) Number:
[
What is the Card ID?
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Billing Information:
Organization Name (Optional):
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Country:
Phone Number:
Email Address: