Cardholder Name:
(as it appears on card)
Address and
City/St/Zip:
MWSC Bond number
(if known):
Phone Number:
Email address:
Credit Card Number:
Card Type:
(Visa, Mastercard, etc.)
Expiration Date:
Amount due
(per 2012 Dues Invoice)
Add:   Processing fee:
Total Charge Amount:
 I authorize Maplewood Swim Club to deduct this
amount for Club dues from the credit card
information I have provided.
Comments:
Save this number, it is the
transaction  confirmation number:
3498700098
PRINT OR SAVE THIS SCREEN BEFORE SUBMIT FOR YOUR RECORDS

After payment by credit card, mail in your completed dues invoice to:
Maplewood Swim Club, PO Box 125, Southampton, PA 18966
Dues Payment Form (via Credit card)
Rates are shown on Dues Invoices
1169 Rozel Ave
Southampton, PA 18966
215-357-1413