Hav-DOG-Lah 2024
CONTACT INFORMATION
First Name
Last Name
Email Address
Phone Number
Member of WHC?
Yes
No
ATTENDEE INFORMATION
How many people will attend this event (including yourself)?
How many dogs will attend this event?
Does anyone in your group have any dietary restrictions or food allergies? (vegetarian? vegan? gluten free? etc.)
If yes, please explain here:
Would you like to make a donation to WHC?
Yes
No
Enter the amount below.
$
Order Total
$
PAYMENT OPTIONS
How would you like to pay your bill?
Credit Card
ACH (Direct Bank Debit)
CREDIT CARD INFORMATION
To help defray the cost of WHC's credit card processing, a 3% fee will be added to your to credit card payments. There is no fee for ACH payments.
Fee Amount
$
Grand Total
$
First Name on Card
Last Name on Card
Credit Card Number
Expiration Month
Please select...
01
02
03
04
05
06
07
08
09
10
11
12
Expiration Year
Please select...
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
CVV
Billing Street
Billing City
Billing State
Please select...
Alabama
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District Of Columbia
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Texas
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Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Billing Zip Code
ACH INFORMATION
Bank Account Type
Checking
Savings
Bank Name
Account Holder's Name
Bank Account Number
Bank Routing Number
Publicly Hidden Fields
Payment Section
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Auth.net Connector Billing Info
Auth.net Payment Info
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