Payment for Selectable Fee Options

In this sample form, customers can choose the fee options they want. The amount users have to pay will depend on the selected options.

Membership Plan *

6 Months Membership(60$)

9 Months Membership(90$)

12 Months Membership(120$)

Print Member Card

Yes(+10$)

First Name *

Last Name *

Address *

City *

Zip *

Country *

State *

Email *

Total Amount

$

Payment method *

Paypal
Authorize.net
Offline Payment
SnapPay
Payrexx