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["PAYMENT REQUEST"]
[]
["REQUEST DATE:"]
[]
["DATE PAYMENT NEEDED:"]
[]
["AMOUNT:"]
[]
["PAYEE:"]
["Made Payable To: "]
["Attn: (If different from above)"]
["Address"]
["City, State, Zip "]
[]
["EXPLANATION (place an X on one and provide additional information)"]
["Tournament Application Fee:"]
["Tournament Name: "]
[]
["Referee:"]
["Team/Coach:"]
[]
["Field Rental:"]
["Explanation:"]
[]
["Other:"]
["Explanation:"]
[]
["REFERENCE # ON PAYMENT:"]
[]
["RETURN PAYMENT TO (place an X on one and provide additional information)"]
["Mail payment to payee: "]
[]
["Pay by venmo?"]
["Venmo Information:"]
[]
["Pay by credit card?"]
["credit card payment instructions:"]
[]
["Other instructions:"]
["Instructions:"]
["PLEASE E-MAIL TO JWARREN@SPORTINGCOLUMBUS.COM WITH COPY OF INVOICE"]