................		 SECURED CREDIT CARD PAYMENT FORM

Thank You for interest in joining United Anglers.  Your contribution is very valuable to us in our struggle for quality fishing today and tomorrow.  To make a secured payment with credit card please completely fill out this form below - all red fields are required.


Privacy Note: All personal information on this page is private.  It will be used for processing your credit card and for us to reply to you only.  We will not transfer any of the information to third parties.   We will not ask you to send your sensitive personal information over unsecured email.  We will reply to you at the provided email address to confirm your online payment.  

First Name  
Middle Name
Last Name
Organization 
United Anglers
Member ID		     (Optional)


Contact Information (Required - same as the one you use for your credit card):
Address:
Address (2nd line):
City:
State:
ZIP:
Phone:
Email

 Payment Information (Required):
Member Payment:
Additional
Donation Amount:
Total Payment:
Payment Method:
Card Number:
Expiration Date:
3-digits Secured Code
(back of the card)


Transaction Note:



Click the Submit Payment button to continue.  By Submitting the Payment, you are authorized us to charge the agreed amount on this form to the provided credit card above.



If you disagree and wish to cancel the transaction, please click the Cancel button and return to the home page


This form is for credit card payment only, if you prefer to make a payment with check or money order, please click here to go back to Member page and download the form.


United Anglers of Southern California (UASC) is a 501(C)(3) Non-profit Organization -
Tax Exemption ID # 33-0558487.  
Donation to UASC is tax deductible to the extent allowable by the law.


United Anglers of Southern California
17391 Murphy Ave Suite A
Irvine, CA 92614-5919
(ph) (949) 863-9447, (fax) (949) 863-9482
www.unitedanglers.com
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