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	[3]
Please Describe this Payment	[4]
Please Describe this Payment	[5]
Please Describe this Payment	[6]
Please Describe this Payment	[7]
Please Describe this Payment	[8]
Please Describe this Payment	[9]
Please Describe this Payment	[10]

6th Grade Fees

6th Grade Registration:

$70.00

Select:

Item Subtotal:

$0.00

7th Grade Fees

7th Grade Registration:

$110.00

Select:

Item Subtotal:

$0.00

8th Grade Fees

8th Grade Registration:

$85.00

Select:

Item Subtotal:

$0.00

9th Grade Fees

9th Grade Registration:

$120.00

Select:

Item Subtotal:

$0.00

Total:

$0.00

Parent/Guardian Info

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

Convenience Fees:

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

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:

Billing ZIP/Postal Code:


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