Please use this secure "generic" payment form to manually, yourself enter the quantity of either ONE Dollar .. or .. ONE-THOUSAND Dollar increments, or any combination of each.  Please note that this is a secure site and after you submit the quantity you will be taken to Formsite's certified secure site to process your transaction via

Thank you, WalCom -Registration & Logistics Services.
IF you have any questions, please call us at:  740.524.4123
Enter a number: 0, 1, 2, 3, etc. For BOTH options! *