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9067 S 1300 W Ste 303 West Jordan UT 84088
PH: (801)721-6329 FX: (888)670-0032
Email: info@mountainheightsacademy.org
http://www.mountainheightsacademy.org/
FEES Payment
Student's Name
What Are You Paying For
Activities/Clubs
Chromebook Rental
Chromebook Repair/Replace
Concurrent Enrollment Courses and/or Supplies
Credit Recovery
Original Credit Courses
School Supplies
Shipping Costs
Testing (AP, etc.)
Please list the specific items being paid for below.
Total:
$
Item Subtotal:
$0.00
Total:
$0.00
Personal Information:
First Name:
Last Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Payment Information:
Processing Fee Rates:
Cards:
3% ($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*MOUNTAIN HEIGHTS
'
and the service fee transaction as '
CBT*SVC FEE MOUNTAIN
'.
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