Hawthorn Academy West Jordan

Please describe in detail the fee in which you are paying

Student's Full Name

Student's Grade

Donation Category

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Donations

Student One Donation:

Item Subtotal:

$0.00

Student Two Donation:

Item Subtotal:

$0.00

Student's Full Name
Student's Grade
Donation Category

Student Three Donation:

Item Subtotal:

$0.00

Total:

$0.00

Parent/Guardian Info

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:	$0.50

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:

Change Payment Method

Your statement will describe your payment as

CBT*HAWTHORN ACADEMY and the service fee transaction as CBT*SVC FEE HAWTHORN

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