SIPlive: North Davis Preparatory Fees (L.?)

Student's First Name, Last Name, Student ID# and Grade	Lastname	,	Firstname	-	ID #	-	Grade
Student's First Name, Last Name, Student ID# and Grade

Dollar Dress ($9.00 for the entire year):

$9.00

Quantity:

Item Subtotal:

$0.00

Student's First and Last Name	[1]
Student's First and Last Name	[2]
Student's First and Last Name	[3]
Student's First and Last Name	[4]
Student's First and Last Name	[5]
Student's First and Last Name	[6]
Student's First and Last Name	[7]
Student's First and Last Name	[8]
Student's First and Last Name	[9]
Student's First and Last Name	[10]

Dollar Dress Day is $9.00 for the entire year.

Field Trip:

Item Subtotal:

$0.00

Teacher's Name	[1]
Description	[1]
Teacher's Name	[2]
Description	[2]
Teacher's Name	[3]
Description	[3]
Teacher's Name	[4]
Description	[4]
Teacher's Name	[5]
Description	[5]
Teacher's Name	[6]
Description	[6]
Teacher's Name	[7]
Description	[7]
Teacher's Name	[8]
Description	[8]
Teacher's Name	[9]
Description	[9]
Teacher's Name	[10]
Description	[10]

Fine:

Item Subtotal:

$0.00

Description	[1]
Description	[2]
Description	[3]
Description	[4]
Description	[5]
Description	[6]
Description	[7]
Description	[8]
Description	[9]
Description	[10]

Library Fine:

Item Subtotal:

$0.00

Kindergarten Kits:

Item Subtotal:

$0.00

3rd Grade Novels:

Item Subtotal:

$0.00

4th Grade Novels:

Item Subtotal:

$0.00

Replacement Planners:

$5.00

Quantity:

Item Subtotal:

$0.00

ID Card:

$5.00

Quantity:

Item Subtotal:

$0.00

Other:

Item Subtotal:

$0.00

Description of Payment	[1]
Description of Payment	[2]
Description of Payment	[3]
Description of Payment	[4]
Description of Payment	[5]
Description of Payment	[6]
Description of Payment	[7]
Description of Payment	[8]
Description of Payment	[9]
Description of Payment	[10]

Total:

$0.00

Parent/Guardian Information

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

Payment Information

Method of Payment:

Processing Fee Rates:

Cards: 3% plus $0.50 ($1.50 min)
(4.5% for foreign cards)

eCheck (ACH): $0.49

	Update name from Parent/Guardian Information
Name of Individual on Checking Account: Name of Individual on Savings Account: Name of Business on Checking Account:
Bank Routing Number:
Bank Account Number:
Confirm Account Number:

Credit Card Number:	(Type number or swipe with cursor in this empty field)
Expiration Date:	/
Card ID (CVV2/CID) Number:	What is the Card ID?

Cardholder Information (exactly as it appears on your statement)
	Update from Parent/Guardian Information
Cardholder's Name:
Billing ZIP/Postal Code:

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