2018-2019 Credit Card Payment (Peterborough Girls Hockey Association)

Players Name^*

Required

Division^*

Novice Rep
Atom Rep
Peewee Rep
Bantam Rep
Midget Rep
Intermediate A
Senior A
Tyke/Novice House League
Atom House League
Peewee House League
Bantam Midget House League
Initiation Program

Required

Payment Amount^*

Required

Name as it appears on credit card^*

Required

Type of Credit Card - VISA and MasterCard only^*

VISAMasterCard

Required

AmEx and VISA debit not accepted. A service charge will be applied to all CC payments

Credit Card Expiry^*

Required

Credit Card Number - PLEASE INSERT AT LEAST ONE SPACE OR - WHEN ENTERING ^*

Required

Postal Code^*

Required

CVV Number from back of card^*

Required

Email Address^*

Required

Example: [email protected]

2018-2019 Credit Card Payment (Peterborough Girls Hockey Association)

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