CREDIT CARD PAYMENT INFORMATION

Please e-mail or fax this information to Dr. Robert P. Ellis
robert.ellis@colostate.edu

CRWAD dues and meeting registration fees may be paid by credit card.  If you are paying meeting registration fees a completed pre-registration form must accompany the credit card information.
Accepted cards are: MasterCard, VISA, American Express, and Discover credit cards.

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If you would like to make payment by credit card please complete and e-mail or fax the following information.

Credit Card Number ________________________________________
Expiration Date __________
Verification No. (This is the 3 digit number - it may follow a 4 digit number- which appears on the signature strip on the back of the card) ______
Name on the card _______________________________________
Street Address _________________________________________
Zip/Country Code _______________
Type of credit card (Visa, MasterCard, American Express, or Discover) _______________
What are you paying (Dues and/or registration) _________________________________________
Amount you are paying _______________