SIPlive: Quest Academy


Quest Academy Charter School

Student Last Name, First Name	Last Name	,	First Name
Student Last Name, First Name

Replacement Badge:

$5.00

Select:

Item Subtotal:

$0.00

Library Fines:

Item Subtotal:

$0.00

Field Trips:

Item Subtotal:

$0.00

Please select the Student's Teacher.				[1]
Please select the Student's Teacher.				[2]
Please select the Student's Teacher.				[3]
Please select the Student's Teacher.				[4]
Please select the Student's Teacher.				[5]
Please select the Student's Teacher.				[6]
Please select the Student's Teacher.				[7]
Please select the Student's Teacher.				[8]
Please select the Student's Teacher.				[9]
Please select the Student's Teacher.				[10]

Other:

Item Subtotal:

$0.00

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Please Describe this Payment	[10]

Not selling yearbooks until January.

Junior High Registration Fees

6th Grade Fees

6th Grade Registration:

$95.00

Select:

Item Subtotal:

$0.00

7th Grade Fees

7th Grade Registration:

$110.00

Select:

Item Subtotal:

$0.00

8th Grade Fees

8th Grade Registration:

$120.00

Select:

Item Subtotal:

$0.00

9th Grade Fees

9th Grade Registration:

$125.00

Select:

Item Subtotal:

$0.00

*Online Elective Fee:

$35.00

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Item Subtotal:

$0.00

*Only pay if scheduled for this class.

Total:

$0.00

Parent/Guardian Info

First Name:		Last Name:
Phone:
Email:

Please be aware that Card Payments will be described as
"Schools 800-764-0844 Clinton UT" on your statement.

Payment Information

Method of Payment:

Processing Fee Rates:

Cards: 3% plus $0.50 ($1.50 min)
(4.5% for foreign cards)

eCheck (ACH): $0.50

	Update name from Parent/Guardian Info
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)
	Update from Parent/Guardian Info
Cardholder's Name:

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