Located in the top left corner of remittance stub. | |
Invoice No.: | |
Located in the top left corner of remittance stub. | |
Company Name: | |
Contact Name: | |
Phone: | |
E-Mail: | |
Credit Card Information | |
Your credit card information will be transmitted to LSBA via a secure internet connection. | |
Billing First Name: | |
Billing Last Name: | |
Billing Address 1: | |
Billing Address 2: | |
Billing City: | |
Billing State: | |
Billing Zip Code: | |
Billing Day Phone: | |
Credit Card Type: | |
Credit Card Number: | |
Credit Card Expiration: | |
Credit Card Security Code: | |
Membership Dues $100.00 Annually Dues to LSBA are not deductible as charitable contributions for federal income tax purposes. Dues may be deductible as an ordinary business expense. |
|