Paradigm High School

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Balances For 2016-2017

Student's Full Name and Grade	Last Name	,	First Name	-	Grade
Student's Full Name and Grade

2016-2017 Balance:

Item Subtotal:

$0.00

Please describe 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% surcharge 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

Please be aware that payments will reflect on your statement as

CBT*PARADIGM HIGH SCH and CBT*SVC FEE PARADIGM

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