Canyon Grove

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STUDENT PAYMENTS

Students Full Name	Last Name	,	First Name	-	Student #
Students Full Name

Parent/Guardian Name

CGA T-Shirt:

$8.00

Quantity:

Item Subtotal:

$0.00

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CGA Crew Sweatshirt:

$15.00

Quantity:

Item Subtotal:

$0.00

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CGA Light Jacket:

$26.00

Quantity:

Item Subtotal:

$0.00

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Library Fee:

Item Subtotal:

$0.00

Description

Misc. Payment:

Item Subtotal:

$0.00

Description of Payment

Total:

$0.00

Payer's Information

First Name:		Last Name:

Email:

Payment Information:

Processing Fee Rates:
Cards:	$2.00
eCheck:	Free

Method of Payment:	Credit/Debit Card eCheck
Update Name from Above

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

Name on Card:
Account Number:
Expiration Date:
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