JR WARRIORS ONLINE PAYMENT FORM
All Fields marked with an asterisk (*) are required.

Player Information   Payment Information
Team:*
First Name:*
Last Name:*
Street:*
Apt:
City:*
State:*
Zip Code:*
Parent/Guardian:*
Phone (Evening):*  ( – 
Phone (Daytime):*  ( – 
Email:*
 
Payment Amount:
Using your 2016-17 Annual Tuition Payment Schedule as a guide, please input the amount that you would like to pay at this time. You have the option of paying electronically in two ways: 1) one in-full, manual payment; or 2) monthly manual payments. If you would like to set up automatic monthly recurring payments, please contact Colleen Amedure via phone (978-557-5518) or email (camedure@valley-associates.com).

Credit Card Type: *
Name on Card: *
Billing Address same as Player's Address
Billing Street:*
Billing Apt:
Billing City:*
Billing State:*
Billing Zip Code:*
Card Number: *
Enter numbers only, no spaces or dashes
Expiry Date *