Approved

Name:

Amount:

Card Type:

Card Number:

Authcode:

AVS Result:

CVV Result:

OK

Yeshivas Toras Moshe

Personal Information

Full Name ^*

Address ^*

Zip code ^*

Phone Number

Email Address ^*

Payment Details

$

Amount ^*

+ Convenience fee: 3%

on credit card transactions

Final Amount

Description ^*

Repeated Payments

Ongoing 2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months 11 Months 12 Months

Credit Card Details

Pay with Check

Card Number ^*

MMYY ^*

CVV

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Routing Number ^*

Account Number ^*

Process Payment

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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

Yeshivas Toras Moshe

1412 E 7TH STREET
Brooklyn, NY 11230

Tell: (718) 336-1770

[response]

ID #[transid]

[created]

[cardholder]

$ [amount]

[cardtype]   [ccnum4]

Authorization Number

[authcode]

AVS Response

[avsresult]

CVV response

[cvcresult]

[otherTransaction]

Thank you for your payment.