Vista School - School Lunch

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

Amount:

Item Subtotal:

$0.00

Total:

$0.00

Parent/Guardian Information

First Name:		Last Name:
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*VISTA SCHOOL and the service fee transaction as CBT*SVC FEE VISTA

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