Student's Name
First Name
Last Name
School Fees
Replacement Name Tag:
$5.00
Select:
Item Subtotal:
$0.00
Fine Arts:
$25.00
Select:
Item Subtotal:
$0.00
Technology:
$25.00
Select:
Item Subtotal:
$0.00
Science Electives:
$25.00
Select:
Item Subtotal:
$0.00
Triathlon (Yearly):
$72.00
Select:
Item Subtotal:
$0.00
Triathlon (Monthly):
$8.00
Select:
Item Subtotal:
$0.00
Weight Training (Per Semester):
$25.00
Select:
Item Subtotal:
$0.00
Weight Training (Yearly):
$50.00
Select:
Item Subtotal:
$0.00
PE Uniform - Shirt:
$8.00
Select:
Item Subtotal:
$0.00
PE Uniform - Shirts (Set of 2):
$15.00
Select:
Item Subtotal:
$0.00
Junior High Yearbook:
$30.00
Select:
Item Subtotal:
$0.00
Sports Fee:
$35.00
Select:
Item Subtotal:
$0.00
Field Trip:
$
Item Subtotal:
$0.00
Name of Field Trip
[1]
Name of Field Trip
[2]
Name of Field Trip
[3]
Name of Field Trip
[4]
Name of Field Trip
[5]
Name of Field Trip
[6]
Name of Field Trip
[7]
Name of Field Trip
[8]
Name of Field Trip
[9]
Name of Field Trip
[10]
School Spirit Clothes:
$
Item Subtotal:
$0.00
Description of School Clothes
[1]
Description of School Clothes
[2]
Description of School Clothes
[3]
Description of School Clothes
[4]
Description of School Clothes
[5]
Description of School Clothes
[6]
Description of School Clothes
[7]
Description of School Clothes
[8]
Description of School Clothes
[9]
Description of School Clothes
[10]
Lunch Payments:
$
Item Subtotal:
$0.00
Lunch Note
[1]
Lunch Note
[2]
Lunch Note
[3]
Lunch Note
[4]
Lunch Note
[5]
Lunch Note
[6]
Lunch Note
[7]
Lunch Note
[8]
Lunch Note
[9]
Lunch Note
[10]
Miscellaneous Fee:
$
Item Subtotal:
$0.00
Please give a description of what the payment is for
[1]
Please give a description of what the payment is for
[2]
Please give a description of what the payment is for
[3]
Please give a description of what the payment is for
[4]
Please give a description of what the payment is for
[5]
Please give a description of what the payment is for
[6]
Please give a description of what the payment is for
[7]
Please give a description of what the payment is for
[8]
Please give a description of what the payment is for
[9]
Please give a description of what the payment is for
[10]
Total:
$0.00
Payer's Information
First Name:
Last Name:
Phone:
Email:
Payment Information
Processing Fee Rates:
Cards:
3% plus $0.50 ($1.50 min)
(4.5% for foreign cards)
eCheck (ACH):
$0.49
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
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Please be aware that payments will reflect on your statement as
Schools 800-764-0844 Clinton UT
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