Anglican Province of America - Credit Card Authorization Form

Credit Card Authorization Form

Please complete all fields.

Credit Card Information

VISA

MasterCard

Discover

AMEX

Cardholder Name (as shown on card):

Card Number:

CVV:

Expiration Date:

Cardholder Address & ZIP Code:

I authorize Matthew Stuart (APA Webmaster) to use my credit card above for agreed upon purchases: annual subscriptions to Squarespace.com & Hover.com. I understand that my information will NOT be saved or used for any other purpose.

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