Test This page is for testing various forms See https://stripe.com/docs/testing for test CC numbers Make Payment For:Select one...Other PaymentBalance for Basketball TeamHow many players are you paying for?Select one...12345Player 01 - First Name *Player 01 - Last Name *Payment Options (1 Player) *Select one...Pay in Full ($400)Pay in 4 Installments ($110 x 4)Player 02 - First Name *Player 02 - Last Name *Payment Options (2 players) *Select one...Pay in Full ($780)Pay in 4 Installments ($205 x 4)Player 03 - First Name *Player 03 - Last Name *Payment Options (3 players) *Select one...Pay in Full ($1,140)Pay in 4 Installments ($295 x 4)Player 04 - First Name *Player 04 - Last Name *Payment Options (4 players) *Select one...Pay in Full ($1500)Pay in 4 Installments ($385 x 4)Player 05 - First Name *Player 05 - Last Name *Payment Options (5 players) *Select one...Pay in Full ($1860)Pay in 4 Installments ($475 x 4)Payment Amount *USDPayment Details *Please describe what you are making a payment for.Billing DetailsPayment Total$Confirm Payment Option *One TimeConfirm Payment Option *Four PaymentsBilling - First Name *Billing - Last NameBilling Email Address *Billing - Street Address *Billing - Apartment, suite, etcBilling - City *Billing - State *Billing - ZIP *CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePayment MethodCredit / Debit CardACH / eCheckCredit / Debit CardOne Time PaymentCredit / Debit Card *Credit / Debit CardFour PaymentsCredit / Debit Card Number *Expiration Month *Expiration Year *CVV Code *ACHAccount Type *Select one...CheckingSavingsRouting Number *Bank Account Number * 4 installment plans for our teams will draft on either the 10th or 25th of each month. * There will be a processing fee of up to 3.5% added to each monthly payment. The date will be determined by when the form is submitted. Drafts will occur on the next date of the above options. By submitting this form you certify that you have reviewed the information above and authorize Fire Sports & Recreation to take payment(s) as described. Submit PaymentPlease do not fill in this field.
