Pleon Yacht Club - Supplemental Payment Form

Supplemental Payment Form

Did your credit card fail upon initial attempts during your online registration process? Would you like to try a different credit card? Please enter your registration total below, and fill out your billing information. If you are unable to charge your credit card(s) on this web site, we ask that you mail payment to Pleon:
Pleon Junior Sailing Program, P.O. Box 160, Marblehead, MA 01945

First Name: (leave this field blank)
Last Name: (leave this field blank)

Payment For:	Pleon Supplemental Payment Forrm
Amount: *	$ (whole dollars, no commas)
	Billing Information
Name on Card: *
Address: *
City: *
State: *
Zip Code: *
Country:
Phone: *
Email Address: *
	Credit Card Information
Card Type: *
Card Number: *
Expiration: *
	Other Information
What is the purpose of your supplemental payment?: *	(ie. summer program registration, membership, etc.)
	* indicates required information
(The next screen will require you confirm your information before payment submission.)