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PLC:

a003ku

Agency:

town of excelsior

For:

excelsior tax payments

Phone:

608-522-5115

Address:

100 east broadway
rock springs, wisconsin 53961

*Required Field

Payment Information

*Payor Name:

Middle:

*Last:

Taxee Name (If different from Payor Name):

Middle:

Last:

*Property Tax Address:

*City:

*State:

*Zip:

*Parcel # 1:

Parcel # 2:

Phone #:

(### - ### - ####)

Notes:

Payment Amount

*Payment Type:

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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