VEPGA Dues Payment

Use this payment form ONLY if you’re paying your VEPGA membership dues with a credit card. Please be sure to enter the exact amount on your invoice and enter the REF# exactly how it appears.* All fields are required.

*If the amount on the invoice is incorrect or needs adjustment, do not complete this form. Please contact Sue Mellen at smellen@vml.org.

Amount*
Include the amount shown on your invoice here.
Reference*
Enter the REF# that appears on your invoice.
Name*
First Last
Phone*
Email*
Address
Enter the address that appears on your invoice.

Street Address Address Line 2 City State ZIP Code
- Same as Mailing Address
Billing Address
Please enter billing address associated with your payment method.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Total
$0.00
Credit Card*
Card Details
Cardholder Name