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SMAC ARIZONA PAYMENTS
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8
Questions
START
1
Name of Player or Team Name
Please Enter Team Name in Second Field
First Name
Last Name or Team Name
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2
Name of Customer Making Payment
First Name
Last Name
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3
Email
This email address will get the receipt.
example@example.com
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4
Phone Number
Area Code
Phone Number
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5
Select Your Teams Gender
Select
Male
Female
Multiple
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6
Coaches Name
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7
Enter Description of Payment
Any additional information you want to add
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8
SMAC PAYMENT
*
This field is required.
ENTER THE TOTAL AMOUNT OF PAYMENT
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( X )
Description
USD
+ OR enter a custom value
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
Expiration Year
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Should be Empty:
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