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?

Name

First Name

Last Name

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Address

Country

Address Line 1

City

State

Postal Code

Cardholder Name

Credit Card #

Visa MasterCard American Express

Expiration Date

Security Code

Your payment will be

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