St. Patrick Church

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Team Payments

Qty

Description

Amount

Total

ACTS - Women Team Payment

$160.00

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ACTS - Women Team Payment

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Other Amount

ACTS - Men Team Payment

$160.00

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ACTS - Men Team Payment

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Other Amount

Choose A Frequency

Recurring Frequency:

Total: $0.00

Your Information

First Name: *

Last Name: *

Member ID:

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Home Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Retreat Serving/
Retiro Sirviendo:

Name of person serving/ Nombre de persona sirviendo:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *