BCHL 2020/21 Credit Card Payment Form (Brantford Community Hockey League)
COVID -19 UPDATED INFORMATION
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BCHL 2020/21 Credit Card Payment Form
Please complete this form if you wish to pay for your registration fees by Credit Card. Alternately, you can pay by ETRANSFER to
[email protected]
- please include players name in the message portion of the email transfer. ***THIS IS A SECURE FORM AND INFORMATION WILL NOT BE SHARED OR SAVED***
Player Information
Name
*
First and Last Name
Date of Birth
*
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Contact Information
Name of Parent or Guardian
*
First and Last Name
Main Phone Number
*
eg. ###-###-####
Email Address
*
Your confirmation email will be sent to this address.
Payment Information
***The ONE-TIME Season Registration fee of $100.00 will automatically be added to all player fees.
Select Division Fee
*
Select One...
Little Saints $150.00
U7 IP $150.00
U8 & U9 Novice $150.00
U10 & U11 Atom $195.00
U12 & U13 Peewee $195.00
U14 & U15 Bantam $195.00
U16/U18/U21 Mid/Juv $135.00
GOALIES $100.00
OVERDUE SEASON FEES - MARK AMOUNT IN COMMENT BOX
Card Type
*
VISA
MASTERCARD
Card Number
*
Expiry Date
*
Security Code
*
Number found on back of card
Are you paying for multiple players?
List names of all players you are making payments for
Outstanding 2019/20 Season Fees
Please write in FULL AMOUNT or PARTIAL PAYMENT and the amount you wish to pay.
Human Validation
Check The Box
*
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