Please Enter Your Payment Details Below To Proceed (FOR DEMO PURPOSE ONLY) Please enable JavaScript in your browser to complete this form.1Details About you2Payment Details3Processing4FinalizingRegistrant Name *FirstLastEmail *Your emailNext StepIs this a Renewal or Registration? *New RegistrationRenewal FeePlease select an optionHow would you like to pay? *Cash AppVenmoZelleFacebook PayPayPal.meCheckDebit/Credit cardIMPORTANT INSTRUCTIONS CASHAPP USERS: DO NOT CLOSE THIS WINDOWS Please Click on the QR Code or scan to pay with CASHAPP APP the AMOUNT of $75 then return here to complete your process Please Scan or Clickto Pay $75 with CashappIMPORTANT INSTRUCTIONS CASHAPP USERS: DO NOT CLOSE THIS WINDOWS Please Click on the QR Code or scan to pay with CASHAPP APP the AMOUNT of $60 then return here to complete your process Please Scan or Clickto Pay $60 with CashappIMPORTANT INSTRUCTIONS FACEBOOK PAY USERS: DO NOT CLOSE THIS WINDOWS Please Click on the QR Code or scan to pay with FACEBOOK PAY the AMOUNT of $75 then return here to complete your process Please Scan or Clickto Pay $75 with FB PayIMPORTANT INSTRUCTIONS FACEBOOK PAY USERS: DO NOT CLOSE THIS WINDOWS Please Click on the QR Code or scan to pay with FACEBOOK PAY the AMOUNT of $60 then return here to complete your process Please Scan or Clickto Pay $60 with FB PayIMPORTANT VENMO USERS INSTRUCTIONS: DO NOT CLOSE THIS WINDOWS Please click on this QR Code to pay online or scan this code with your PHONE CAMERA. Once the AMOUNT OF $75 is paid come back to complete your process Please Scan or Clickto Pay $75 with VenmoIMPORTANT VENMO USERS INSTRUCTIONS: DO NOT CLOSE THIS WINDOWS Please click on this QR Code to pay online or scan this code with your PHONE CAMERA. Once the AMOUNT OF $60 is paid come back to complete your process Please Scan or Clickto Pay $60 with VenmoIMPORTANT PAYPAL USERS INSTRUCTIONS: DO NOT CLOSE THIS WINDOWS Please click on this QR Code to pay online or scan this code with your PHONE CAMERA. Once the AMOUNT OF $75 is paid come back to complete your process Please Scan or Clickto Pay $75 with PaypalIMPORTANT PAYPAL USERS INSTRUCTIONS: DO NOT CLOSE THIS WINDOWS Please click on this QR Code to pay online or scan this code with your PHONE CAMERA. Once the AMOUNT OF $60 is paid come back to complete your process Please Scan or Clickto Pay $60 with PaypalIMPORTANT INSTRUCTIONS ZELLE USERS: DO NOT CLOSE THIS WINDOWS Please Click on the QR Code or scan to pay with Zelle APP or your bank account (if already enrolled) the AMOUNT of $75 then return here to complete your process Please Pay $75 to [email protected]IMPORTANT INSTRUCTIONS ZELLE USERS: DO NOT CLOSE THIS WINDOWS Please Click on the QR Code or scan to pay with Zelle APPor your bank account (if already enrolled) the AMOUNT of $60 then return here to complete your process Please Pay $60 to [email protected]New Registration CheckPlease send your New Registration check(s) payable to Wallet Up ($25.00 returned check fee) Our Address: P.O. BOX 4562 Hagerstown, MD 21742 Renewal CheckPlease send your Renewal check(s) payable to Wallet Up ($25.00 returned check fee) Our Address: P.O. BOX 4562 Hagerstown, MD 21742 Go BackContinueTake the stress and the guess off your shouldersDo you want to make this a recurring renewal? *Yes I want to renew $60 per yearNo, I'm not interestedDo you want to make this a recurring renewal? *Yes I want to save timeNo, I'm not interestedYou Pay $75 today for first time. And $60 each year afterward. You can request cancellation at anytime.Your total today *$0.00Debit/Credit CardCardName on CardWas your payment successful? *YesNoWhat is your Cash App Username? *What is your FaceBook Pay Username or ID? *What is your Venmo Username? *What is your Paypal.me Username? *Sorry we can not process your request. Payment is required to complete your form. Try Again Go BackContinueUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.Payment Date *Go BackProceed now Need the same form? Grab it here Click here to try it on a Page
