SIPlive: Ogden Preparatory

Student's Name	First Name		Last Name
Student's 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

Method of Payment:

Processing Fees:

Credit cards: 3% plus $0.50 ($1.50 min)
(4.50% 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:
Confirm 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)
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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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