Approved
Name:
Amount:
Card Type:
Card Number:
Authcode:
AVS Result:
CVV Result:
OK
OK
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Personal Information
First Name
Last 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
Cardholder Name
*
Card Number
*
MMYY
*
CVV
?
Account Holder Name
*
Routing Number
*
Account Number
*
Process Payment
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Credit & Debit Processing | Electronic Check Services | Gift & Loyalty Programs | Customized POS Solutions
American Friends Of Yeshivas Toras Moshe
1412 East 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]
