BCHL Credit Card Payment Form (Brantford Community Hockey League)
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BCHL Credit Card Payment Form
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BCHL Credit Card Payment Form
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BCHL Credit Card Payment Form
Please complete this form if you wish to pay for registration fees, sponsorships or Select items by Credit Card. Alternately, you can pay by ETRANSFER to
[email protected]
- PLEASE INCLUDE PLAYERS NAME OR REASON IN THE MESSAGE PORTION OF THE EMAIL TRANSFER. ***THIS IS A SECURE FORM AND INFORMATION WILL NOT BE SHARED OR SAVED***
Player Information
Player Name/Business Name
*
First and Last Name
What is this payment for?
*
eg. jersey fee/sponsorship
Contact Information
Name of Parent/Guardian/Administrator
*
First and Last Name
Main Phone Number
*
eg. ###-###-####
Email Address
*
You will NOT receive confirmation of this form for security of personal information..
Payment Information
Select all items you are submitting payment for
Select Amount to be charged to your Credit Card
*
Little Saints $160
U6 and U7 Tyke $400.00
U8 and U9 Novice $400.00
U10 and U11 Atom $475.00
U12 and U13 Peewee $475.00
U14 and U15 Bantam $475.00
U16 to U21 MID/JUV $375.00
ALL GOALIES $100.00
Select Jersey Fee $100
SPONSORSHIP
Select Team Apparel
OTHER
Check All That Apply
TOTAL AMOUNT TO BE CHARGED TO CC
*
Card Type
*
VISA
MASTERCARD
Card Number
*
Expiry Date
*
ANY ADDITIONAL INFORMATION
Are you paying for multiple players?
List names of all players you are making payments for
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again