ANMC Political Action Committee

Order Details
Payment Made Now
Recurring Payment	$50.00 Monthly auto-debits starting 01/06/2025

Contact / Shipping
First Name*
Last Name*
Email*
Verify Email*
Address*
City*
State*
Zip*
Country*
Phone*

Billing Address
Copy Contact
Billing Address*
Billing City*
Billing State*
Billing Zip*
Billing Country*

Billing
Name On Card*
Credit Card Number*
Card Expiration Date*	/
Card Verification Code*	what's this?

First Name on Account*
Last Name on Account*
Bank Name*
Routing Number*	what's this?
Verify Routing Number*
Account Number*
Verify Account Number*

*Required

I authorize ANMC Political Action Committee to debit the account listed hereon $50.00, & agree to perform the issuer obligations. I authorize ANMC Political Action Committee to auto-debit the account listed hereon $50.00 Monthly starting 01/06/2025 & agree to perform the issuer obligations. I affirm that the information entered on this form is true and correct.

ANMC Political Action Committee
3167 San Mateo NE, #144 Albuquerque, NM 87110
(505) 750-1302

To protect your client's privacy, our secure server uses secure socket layer (SSL). This ensures that the billing information is encrypted and cannot be read as this information is transferred over the internet.