UALOCAL11.COM
Secure Payment Form
Order Summary:
Order Date:
03/19/25
Dues 2025:
Active Member 2025 ($36)
Retired w/40 yrs ($10)
Owner Operator 2025 ($39)
Retired 2025 ($27)
Retired over 65 ($20)
Quanity:
One Month(1)
Two Months(2)
Three Months(3)
Six Months(6)
Nine Months(9)
Twelve Months(12)
Total Dues Owed:
Reinstatement Fee:
Reinstatement Fee($50)
Total Due for Reinstatement:
Total Due: <#000000>
UMamount
Description:
Credit Card Information:
Card Type:
Visa
MasterCard
Discover
Name as on Card:
Card Billing Street Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date:
MMYY
Card ID (CVV2/CID) Number:
[
What is the Card ID?
]
Member Information:
First Name:
Last Name:
Phone Number:
Email Address: