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Pay by Credit Card Via Paypal (Click on the Logo)

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Statement of Dues  (Print Out)

New York City     Total Dues  51.50 Via Paypal

Name:_______________________________________________

Address:_____________________________________________

City/State/Zip_________________________________________

_____________________________________________________

Company Information:____________________________________

Email:

Make check to: Honorable Order of the Blue Goose, INTL

Please print out and send your check to:

Independent Adjustment Co.

Michael Nardulli

22 West Main Street  Suite 14

Patchogue, NY 11772


 
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