Player's Choice Lacrosse Camps Online Balance Payment Form |
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First Name:
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Last Name:
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Email:
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Telephone:
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| Credit Card Information: | . |
| Check one: | Visa MasterCard American Express |
| Name on card: | |
| Card number: (please incude spaces) |
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| Expiration date: | |
| Amount to be charged: | |
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Credit card billing address (REQUIRED)
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| Address: |
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Telephone:
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By clicking the submit button below, I authorize Player's Choice to charge my credit card the amount indicated. I am aware of this charge, and understand that it is to pay the balance of tuition for Player's Choice lacrosse Camps at the University of Massachusetts at Dartmouth.
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