SIPlive: Highmark Lunch 2018-19 (L.?)

Student's Name

Student's Grade

Only order for one student at a time.
If you order for more than more than one student, your order will not process properly.
Sorry for any inconvenience this may cause you.

Payer's Information

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

Payment Information

Method of Payment:

Processing Fees:

Credit cards: 3% plus $0.50 ($1.50 min)
(+1.50% processing fee for AMEX cards)
(+1.5% processing fee for foreign cards)
eChecks: $0.49

	Update name from Payer's 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:

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 Payer's Information
Cardholder's Name:

Billing ZIP/Postal Code:

Please be aware that payments will reflect on your statement as

Schools 800-764-0844 Clinton UT


SIP Program & Data © 2006-2019 Instant Payments All rights reserved. ~ Terms & Conditions ~ Privacy Policy ~ Contact Us ~ SIP Version 2.23; API: 2.9