Riverdale Senior Services : test : Flea Market and Raffle Purchases

Flea Market and Raffle Purchases

Check below what you are purchasing and for what amount.

Purchase Amount

Flea Market Purchase

What is Being Purchased?

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Name

First Name

Last Name

Address

Country

Address Line 1

City

State/Province

Postal Code

Cardholder Name

Credit Card #

Visa MasterCard American Express

Expiration Date

Security Code

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

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