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PLC:

a0027z

Agency:

town of wagram

For:

water & sewer payments

Phone:

910-369-2776

Address:

24421 marlboro street
wagram, north carolina 28396

*Required Field

Payment Information

*Name:

Middle:

*Last:

*Service Address #1:

*Service Address #1 Amount:

Service Address #2:

Service Address #2 Amount:

Service Address #3:

Service Address #3 Amount:

Service Address #4:

Service Address #4 Amount:

Notes:

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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