Jets Hockey Club

Invoice:

*Amount:

PAY BY CREDIT CARD

*Card Number:

*Expiration Date:

(MMYY format)

* CVV2:

What is this?

OR PAY BY ACH

*Account Type:

*Routing Number:

*Account Number:

*I Agree:

I acknowlege that I am an approved signer on the above account and I hereby agree to have my account debited as of this date for the amount specified. If the draft to my account fails, I agree to pay any related NSF fees.

* Signed:

BILLING INFORMATION

*Player Name:

*Cardholder First Name:

*Cardholder Last Name:

*Address:

*City:

*State:

*Zip:

Phone:

*Email: