Approved
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Mosdos Zichron Erez
10 Golar Dr • Monsey, NY 10952
Personal Information
Full Name
*
Address
Zip code
Phone Number
Email Address
*
Transaction Details
$
Amount
*
Description
Repeated Payments
Ongoing
2 Months
3 Months
4 Months
5 Months
6 Months
8 Months
10 Months
12 Months
18 Months
24 Months
36 Months
Credit Card Details
Pay with Check
Card Number
*
MMYY
*
CVV
?
Process Payment
Processing By
Merch Pay, Inc. is a registered ISO of Wells Fargo Bank, N.A., Concord, CA.
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Credit & Debit Processing | Electronic Check Services | Gift & Loyalty Programs | Customized POS Solutions
Mosdos Zichron Erez
10 Golar Dr
Monsey, NY 10952
Tell: (845) 369 - 1315
[response]
ID #[transid]
[created]
[cardholder]
$ [amount]
[cardtype] [ccnum4]
Authorization Number
[authcode]
AVS Response
[avsresult]
CVV response
[cvcresult]
[otherTransaction]
