Bear River Charter School
             
Student's NameFirst NameLast Name
 
School Lunch:   $   Item Subtotal:  
$0.00
4th Grade Trip:   $50.00   Select:   Item Subtotal:  
$0.00
5th & 6th Grade Trip:   $200.00   Select:   Item Subtotal:  
$0.00
Yearbook:   $20.00   Select:   Item Subtotal:  
$0.00
After School Club:   $   Item Subtotal:  
$0.00
School Donation:   $   Item Subtotal:  
$0.00
SCA Shirt Orders:   $   Item Subtotal:  
$0.00
SCA Fund Raiser:   $   Item Subtotal:  
$0.00
SCA School Pictures:   $   Item Subtotal:  
$0.00
SCA Green Science Fair:   $   Item Subtotal:  
$0.00
What do you want this to apply to?
Other Fees:   $   Item Subtotal:  
$0.00
Please give a description of what you are paying for
Total:
$0.00
Parent/Guardian 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% 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

Your statement will describe your payment as

CBT*BEAR RIVER CHTR S’ and the service fee transaction as ‘CBT*SVC FEE BEAR RIVE’

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