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Moneris Test Form

This form demos both using Javascript to total fields with $amounts in the input "values" as well as handing off to Moneris to collect payment.  It also has a checkbox that if clicked, hides the optional contact information to make the form shorter (for returning customers).

Once control is passed off to the Moneris test account you may use these account numbers to try the various types of payment:

  • Visa 4242424242424242
  • MC 5454545454545454
  • Amex 373599005095005
  • Pinless Debit 4496270000164824

And for bank transactions you may use:

Federal Reserve Bank
Routing: 011000015
Account: any 5 to 22 digit number
Check# any

First Name: Last Name:
Email Address:
My contact information already on file is correct
School Name:
Street Address: City:
State: Zip Code:
Dues for first year administrators are $213 (one time benefit only)

District Dues:

Building Fund Donation:
Check here if you would like to donate $35 toward the Building Fund.
Total Remittance:  


Moneris Test Form

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