Common Ground Payment Collection Form
Homeowner Information (We collect this for the purposes of matching your payment to you)
First Name
Last Name
Phone Number
Email
Street Address
City
State
Zip
Payment Information
Payment Amount
Full Name of Cardholder
Credit Card Number
Credit Card Code (3 digits on back of card)
Credit Card Expiration Month
Credit Card Expiration Year
If you have any general notes or comments about this payment, please enter here.
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Contact Information