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Student's Name
First Name
Last Name
School Fees
Replacement Name Tag:
$5.00
Select:
Item Subtotal:
$0.00
Credit Recovery:
$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
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:
$20.00
Select:
Item Subtotal:
$0.00
Field Trip:
$
Item Subtotal:
$0.00
Name of Field Trip
School Spirit Clothes:
$
Item Subtotal:
$0.00
Description of School Clothes
Lunch Payments:
$
Item Subtotal:
$0.00
Lunch Note
Miscellaneous Fee:
$
Item Subtotal:
$0.00
Please give a description of what the payment is for
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)
(1.5% surcharge for foreign cards)
eCheck:
$0.49
Method of Payment:
E-Check
Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
Your statement will describe your payment as '
CBT*OGDEN PREP ACADEM
'
and the service fee transaction as '
CBT*SVC FEE OGDEN PRE
'.
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