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Cup Application Fees

This payment page should only be used to pay Leeds & District FA Cup application fees. Please enter your club name, the total amount and then click on the Pay button below to be redirected to our WorldPay secure online payment portal where you enter your debit or credit card details.

<input name=”instId” type=”hidden” value=”1191063″ /> <input name=”cartId” type=”hidden” value=”Cup Application Fees” /> <input name=”accId1″ type=”hidden” value=”LEEDSANDDISTECOM” />
<strong>Club Name </strong>      <input name=”desc” type=”text” />
<strong>Amount </strong>            <input name=”amount” type=”number step=1 min=0″ />
<input name=”currency” type=”hidden” value=”GBP” />
<input type=”submit” value=” Pay ” /></form>