Secure Payment Form
 

In compliance with the BBB Privacy Policy, the BBB of The Mid-South will use the personal information you provide below only for the purposes for which you provide it.
   
Attendee Name
Company Name
BBB Accredited Business
   
Phone
Email
   
Fees:

Breakfasts:
BBB Accredited Businesses - No charge
Guests - $10

Lunches:
BBB Accredited Businesses - $15
Guests - $20
I am registering for
Number of Guests
Additional Attendee Names
   
   

Payment Information:

  
 
Electronic Check: Checks can be processed electronically. We will need the routing number and account number from your check. These are the numbers listed on the bottom left hand side of your check. You may provide a check number for your reference. You will need to void the check you are using - do not mail this check. The funds for your membership will be deducted from your checking account.
   
Check Number
Check Routing Number
Checking Account Number
(Please list all of the numbers at the bottom of your check from left to right in the above spaces. Please void and retain the check for your records.)
Name of Bank
Amount to Charge
   
   
Credit Card:  
CC#
Expiration date
Name on Card
Amount to be charged
   
Comments
 
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