| |
|
|
| DESCRIPTION |
PRICE |
QTY |
AMOUNT |
| 1 Year Membership ($75 per month) |
$75.00 |
1 |
$75.00 |
| SUBTOTAL |
$75.00 |
| TOTAL |
$75.00 |
|
Please Enter Your Billing Information Below:
|
| Required fields are marked with an asterisk (*).
|
NOTICE: It is the policy of Plug & Pay Technologies, Inc. to respect the privacy of its
customers and the people doing business through its service.
As such all information presented here WILL NOT be sold or distributed to any party other
than the merchant you have currently elected to do business with.
|
| Name:* | |
| Billing Address:* | |
| Line 2: |
|
| City:* | |
| State/Province:* | |
| International Province: | |
| ZipCode/Postal Code:* | |
| Country: | |
| Card Type: |
|
| Credit Card #:* | |
| Exp. Date:* |
|
| Email Address:* | |
| Day Phone #: | |
| Night Phone/FAX #: | |
|
|
| |
| Privacy & Security Policy |
