Channing Hall Association
of Parents, Students, and Staff
CHAPS Family Membership (1 free dress coupon):
$20.00
Select:
Item Subtotal:
$0.00
Number of students attending Channing Hall:
Quantity:
Student's Name
[1]
Student's Name
[2]
Student's Name
[3]
Student's Name
[4]
Student's Name
[5]
Student's Name
[6]
Student's Name
[7]
Student's Name
[8]
Student's Name
[9]
Student's Name
[10]
Student Directory:
$5.00
Quantity:
Item Subtotal:
$0.00
Student's Name
[1]
Student's Name
[2]
Student's Name
[3]
Student's Name
[4]
Student's Name
[5]
Student's Name
[6]
Student's Name
[7]
Student's Name
[8]
Student's Name
[9]
Student's Name
[10]
Used Uniforms:
$
Item Subtotal:
$0.00
Total:
$0.00
Payer's Information
First Name:
Last Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Payment Information
Method of Payment:
Visa
MasterCard
Discover Card
Personal Checking
Personal Savings
Business Checking
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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:
Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
Card ID (CVV2/CID) Number:
What is the Card ID?
Cardholder Information
(exactly as it appears on your statement)
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Payer's Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:
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