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Independence Jr. High Campus Registration
Student's Full Name
Last Name
,
First Name
Student Fees
Registration:
$75.00
Quantity:
Item Subtotal:
$0.00
Yearbook:
$30.00
Quantity:
Item Subtotal:
$0.00
Spirit Shirt:
$15.00
Quantity:
Item Subtotal:
$0.00
Total:
$0.00
Parent/Guardian Information
First Name:
Last Name:
Phone:
Email:
Please be aware that payments will reflect on your statement as
CBT*SUMMIT ACADEMY
and the service fee as
CBT*SVC FEE SUMMIT A
.
Payment Information:
Processing Fee Rates:
Cards:
3% plus $0.50 ($1.50 min)
(1.5% additional service fee for foreign cards)
eCheck:
$0.49
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:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
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CORE Payments Version 4.1.17120; (API: 2.22)
