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Midwest Surfboard Company

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Converge Payment Test

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

Note that if the contact information is filled out it will pre-populate the 'Billing Information' on the next screen.

Once control is passed off to the test account you may use these account numbers to try the various types of payment (any expiration/CVC):

  • Visa 4000000000000002
  • MC 5121212121212124
  • Amex 370000000000002
  • Discover 6011000000000004

And for bank transactions you may use:

Routing: 490000018
Account: any digits up to 16
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:
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: