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Church Of God Of Prophecy

Men's/Parley Secure Payment Form

    
First Name
Last Name
Phone Number
Email Address
Date
Amount
Designation

ie. Men's Retreat Tuition, Parley Tuition

Comments

Include name of campers this payment is for

Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID