BOYS & GIRLS CLUBS OF THE BIG PINES PROGRAM FEES
Secure Payment Form for the Jefferson Unit

 
Recurring Payment:
Order Date: 03/29/24
Customer IP: 3.90.255.22 
Recurring Extension charges are $40 per month  
Recurring Payment Amount:
           
Schedule:
First Payment Date(enter date in YYYYMMDD format):
Number of payments(* for unlimited):
This is for…:
     
   
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
City:
State:
Card Billing Zipcode:
Phone Number:
Email Address:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
 
[What is the Card ID?]