Secure Payment Form

Use this form to make a payment to cover registration fees or recharter, or a payment for unit account. Please do not use for camp registration or activities that have their own payment form
Donation Levels 
  Level Range
    TAC 2016 FOS Shoulder Patch 
$25 and up
* required information
Secure Payment Form
Payment Amount
:* $
Information about the person/unit making the payment
Unit Type:
Unit Number:
First Name:*
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:
ZIP/Postal Code:*
Phone:
Country:
Please indicate the purpose of this payment:*
Payment Information
Payment Method
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Credit Card Type:*
                  
Credit Card Expiration:*
Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
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State:
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Country:*
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