JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
JLB Credit Card Authorization Form 20-21
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Type of credit card
*
Visa
MasterCard
Discover
American Express
Name as it appears on credit card
*
Your answer
Expiration Date
*
Your answer
Credit Card Number
*
Your answer
CCV
*
Your answer
Reason for submitting form (ex. partial dues payment, transfer in dues payment, donation type)
*
Your answer
Amount to be charged
*
Your answer
I agree to the terms and conditions above and authorize The Junior League of Baltimore, Inc. to charge my payment to the credit card listed above.
*
I confirm that I agree to the terms and conditions of the JLB payment plan.
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
