SIPlive: Summit Academy High School -EV (L.?)

Summit High School Registration and Fees

Students Full Name

Registration

Activity Fee:

$45.00

Item Subtotal:

$45.00

Book Rental:

$35.00

Item Subtotal:

$35.00

Locker Rental:

$10.00

Item Subtotal:

$10.00

Computer Lab Fee:

$15.00

Item Subtotal:

$15.00

Elective Fees and Other Charges - (Optional)

Parking Permit:

$15.00

Quantity:

Item Subtotal:

$0.00

Yearbook:

$50.00

Quantity:

Item Subtotal:

$0.00

Decal:

$1.00

Select:

Item Subtotal:

$0.00

Spirit Pack:

$15.00

Select:

Item Subtotal:

$0.00

(Includes Shirt and Decal)

Miscellaneous Fees:

Item Subtotal:

$0.00

Please describe other fees you are paying for.				[1]
Please describe other fees you are paying for.				[2]
Please describe other fees you are paying for.				[3]
Please describe other fees you are paying for.				[4]
Please describe other fees you are paying for.				[5]
Please describe other fees you are paying for.				[6]
Please describe other fees you are paying for.				[7]
Please describe other fees you are paying for.				[8]
Please describe other fees you are paying for.				[9]
Please describe other fees you are paying for.				[10]

Miscellaneous Fees :

Item Subtotal:

$0.00

Total:

$105.00

Payer's Information

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

Payment Information

Method of Payment:

Convenience Fees:

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

	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:	(Type number or swipe with cursor in this empty field)
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 ZIP/Postal Code:

Please be aware that payments will reflect on your statement as

Schools 800-764-0844 Clinton UT


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