Wasatch Charter School

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Student Name	Lastname	,	Firstname
Student Name

Amount to Raise: $37,000
Description: Kindergarten Play, Boat House, Games, Climbing Wall

School Playground - Donation:

Item Subtotal:

$0.00

Total:

$0.00

Memo:

Donor's Information

First Name:	Last Name:
Address:
Address:
City:	State/Province:	ZIP/Postal Code:
Phone:
Email:

Payment Information:

Processing Fee Rates:
Cards:	3% plus $0.50 ($1.50 min) (1.5% surcharge for foreign cards)
eCheck:	$0.49

Method of Payment:
Update Name from Personal/Organizational Information

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

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

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We at Wasatch Charter School want to "Thank You" for your generous donation!

Your statement will describe your payment as ‘CBT*WASATCH CHARTER’ and the service fee transaction as ‘CBT*SVC FEE WASATCH C’

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