Salt Lake Academy High School
             
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:
 
  E-Check
 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*REAL ACADEMY HS

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