SIPlive: City Academy - Misc Fees (L.?)

City Academy - Misc Fees

Student's Name	First and Middle Name		Last Name
Student's Name

Amount:

$

Item Subtotal:

$0.00

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Please describe what the payment is for				[5]
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Please describe what the payment is for				[9]
Please describe what the payment is for				[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

Processing Fee Rates:
Cards:	3% plus $0.50 (4.5% for foreign cards)
eCheck (ACH):	$0.50

Name on Account:
Routing Number:
Account Number:
Institution:

Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:

Change Payment Method

Unnamed Item:

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