City Academy - Misc Fees
Student's NameFirst and Middle Name Last Name
Amount:   $   Item Subtotal:  
Please describe what the payment is for
Would you like to make a donation?:   $   Item Subtotal:  
Personal Information
First Name: Last Name:
Payment Information:
Processing Fee Rates:
Cards: 3% plus $0.50
(4.5% for foreign cards)
eCheck (ACH): $0.50
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
Unnamed Item:      
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