UALOCAL11.COM
Secure Payment Form

 
Order Summary:
Order Date: 07/26/24
Dues 2024:
Quanity:
Total Dues Owed:
Reinstatement Fee:
Total Due for Reinstatement:
Total Due: <#000000> UMamount
Description:
           
Credit Card Information:
Card Type:

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: