City Academy - Misc Fees
             
Student's NameFirst and Middle Name Last Name
 
Amount:   $   Item Subtotal:  
$0.00
Please describe what the payment is for [1]

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[2]

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[3]

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[4]

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[5]

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[6]

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[7]

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[8]

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[9]

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[10]
Would you like to make a donation?:   $   Item Subtotal:  
$0.00
Total:
$0.00
 
Personal Information
First Name: Last Name:
Phone: Email:
Payment Information
Method of Payment:
Processing Fees: Credit cards: 3% plus $0.50
                    (+1.5% processing fee for foreign cards)
eChecks: $0.50
Update name from Personal 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:
Credit Card Number:
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Personal Information
Cardholder's Name:
Billing ZIP/Postal Code:
Unnamed Item:      
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