SIPlive: InTech - Fees (L.?)

2018-19 ICHS Fees

Student	First Name		Last Name
Student

Required General Fees

Textbook/Technology Maintenance:

$75.00

Select:

Item Subtotal:

$0.00

Student Activity/Excursion:

$25.00

Select:

Item Subtotal:

$0.00

Science Lab Fee

Biology:

$40.00

Select:

Item Subtotal:

$0.00

Chemistry:

$40.00

Select:

Item Subtotal:

$0.00

Environmental Science:

$40.00

Select:

Item Subtotal:

$0.00

Physics with Technology:

$40.00

Select:

Item Subtotal:

$0.00

Optional Purchases

Yearbook:

$35.00

Select:

Item Subtotal:

$0.00

PSAT Test (10th and 11th Grade):

$20.00

Select:

Item Subtotal:

$0.00

Calculator Rental:

$10.00

Select:

Item Subtotal:

$0.00

Club Membership Dues

National Honor Society (NHS):

$15.00

Select:

Item Subtotal:

$0.00

FIRST/VEX Robotics:

$30.00

Select:

Item Subtotal:

$0.00

Model United Nations (MUN):

$15.00

Select:

Item Subtotal:

$0.00

Total:

$0.00

Payer's Information

First Name:	Last Name:
Address:
Address:
City:	State/Province:	ZIP/Postal Code:
Phone:	Email:

Payment Information

Method of Payment:

Processing Fees:

Credit cards: 3% plus $0.50 ($1.50 min)
(+1.5% processing fee for foreign cards)
eChecks: $0.49

	Update name from Payer's Information
Name of Individual on Checking Account: Name of Individual on Savings Account: Name of Business on Checking Account:
Bank Routing Number:
Bank Account Number:

Credit Card Number:
Expiration Date:	/
Card ID (CVV2/CID) Number:	What is the Card ID?

Cardholder Information (exactly as it appears on your statement)
	Update from Payer's Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:

Please be aware that payments will reflect on your statement as

Schools 800-764-0844 Clinton UT


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