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PLC:

a003t6

Agency:

city of rye

For:

clerk office payments

Phone:

914-967-7371

Address:

1051 boston post road
rye, new york 10580

*Required Field

Payment Information

*Name:

Middle:

*Last:

*Phone #:

(### - ### - ####)

*Email Address:

*Fee Type 1:

Fee Type 2:

Fee Type 3:

For Dog Renewals: Please enter Dog name and license number in the notes section below.

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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