Payment Form

  This is a secure payment form.  

Merchant Information

Seller:   Mifflin County Library

Transaction Details

Item NumberItem DescriptionTotal
Five Dollars $5.00


Billing Information

This address should match your payment method billing address.
Required fields are marked with an asterisk (*).

  * First Name    
  * Last Name    
  * Street Address 1    
  Street Address 2  
  Street Address 3  
  * City    
  * State/Province    
  * Zip/Postal Code        
  Enter your email address
to receive an email receipt
  Notes to Seller    

Payment Information

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  * Credit Card Number      
  * Expiration Date (mm/yy)   /    
  * CVV2 / CID Value       (What is this?)
  By clicking "Submit", I agree to pay the above total amount according to the card issuer agreement.