Real Academy High School

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Real Academy High School - Student #1

School Fees:

Item Subtotal:

$0.00

Student's First and Last Name

School Donation:

Item Subtotal:

$0.00

Student's First and Last Name
Explanation of Donation

Extra Curricular Dues:

Item Subtotal:

$0.00

Student's First and Last Name
Description of Extra Curricular Event

Fines:

Item Subtotal:

$0.00

Student's First and Last Name
Explanation

Other:

Item Subtotal:

$0.00

Student's First and Last Name
Explantion

Real Academy High School - Student #2

School Fees:

Item Subtotal:

$0.00

Student's First and Last Name

School Donation:

Item Subtotal:

$0.00

Student's First and Last Name
Explanation of Donation

Extra Curricular Dues:

Item Subtotal:

$0.00

Student's First and Last Name
Description of Extra Curricular Event

Fines:

Item Subtotal:

$0.00

Student's First and Last Name
Explanation

Other:

Item Subtotal:

$0.00

Student's First and Last Name
Explanation

Real Academy High Fundraiser

Fundraiser Promo Cards - Student 1/ Buyer:

$15.00

Quantity:

Item Subtotal:

$0.00

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

Fundraiser Opt-Out:

$50.00

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]

Additional Donation:

Item Subtotal:

$0.00

Student's First and Last Name

Fundraiser Card Promo - Student 2/ Buyer:

$15.00

Quantity:

Item Subtotal:

$0.00

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

Fundraiser Opt-Out:

$50.00

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]

Additional Donation:

Item Subtotal:

$0.00

Student's First and Last Name

Total:

$0.00

Additional donation are tax deductible,

please email Jose Rincon if you need a letter for tax purposes.

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:
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

Please be aware that payments will reflect on your statement as

Schools 800-764-0844 Clinton UT

Your statement will describe your payment as ‘CBT*REAL ACADEMY HS’ and the service fee transaction as ‘CBT*SVC FEE REAL ACADEMY’

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