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PLC:

a005nq

Agency:

susquehanna county treasurer and tax claim bureau

For:

small games of chance and bingo licenses

Phone:

570-278-6000

Address:

31 lake avenue
montrose, pennsylvania 18801

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Middle:

*Last:

*Type of Sale:

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Subtotal:

$0.00

Total:

$0.00

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*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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