Wild West Balance Payment Form
Team Name
*
Name
*
First Name
Last Name
Email
*
example@example.com
PAYMENT:
prev
next
( X )
Balance Due
$
2,380.50
Wild West Balance Payment - this includes a 3.5% credit card processing fee
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Credit Card
Submit
Should be Empty: