Payment for Bruriah Gym Uniforms

Please select your gym uniform sizes below. T-shirts are 12.00 (xxl $15.00) Sweatpants are $13.00 (xxl $16.00)

First Name*

Last Name*

Email*

Total Amount

$

Payment method *

Paypal
Credit Card

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Type*

Card Holder Name*