SAFE Association

Post Office Box 130

Creswell, OR 97426-0130

(541) 895-3012

FAX: (541) 895-3014

e-mail: safe@peak.org

 

THE SAFE ASSOCIATION NOW ACCEPTS VISA, MASTER CARD AND AMERICAN EXPRESS. SHOULD YOU WISH TO USE THIS FORM OF PAYMENT, ALL INFORMATION BELOW MUST BE LEGIBLY COMPLETED:

 

 

Check one: Visa _____ MasterCard _____ American Express _____

 

NOTE: IF USING A VISA OR MASTERCARD, ALSO PROVIDE THE 3 OR 4 DIGIT NUMBER (KNOWN AS A V-CODE) FOLLOWING THE CARD NUMBER. FOR SOME ISSUING BANKS THIS IS FOUND ON THE BACK OF THE CARD JUST ABOVE THE SIGNATURE. V-CODE #_______________________

 

THE SAFE ASSOCIATION ACCEPTS VISA, MASTER CARD AND AMERICAN EXPRESS. SHOULD YOU WISH TO USE THIS FORM OF PAYMENT, ALL INFORMATION BELOW MUST BE LEGIBLY COMPLETED:

 

PRINT NAME OF CARDHOLDER_____________________________________________________________

ACCOUNT NUMBER_________________________________________________________________________

AMOUNT $ _______________________ EXPIRATION DATE_______________________

PAYMENT FOR_____________________________________________________________________________

SIGNATURE________________________________________________________________________________

PHONE #____________________________________E-MAIL:_______________________________________