Individual Payment Form

Individual Payment Form

Payment For(Required)

ex: flight overpayment, sponsor fee, reimbursement

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Invoice Number

if applicable

Payment Amount(Required)

Total

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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WGI Sport of the Arts • 1994 Byers Road • Dayton, Ohio 45342 • (937)247-5919 • office@wgi.org

WGI Sport of the Arts
1994 Byers Road
Dayton, Ohio 45342

(937)247-5919

©2024 WGI Sport of the Arts. All rights reserved.