CS Lewis - Fee Payments
Student's Name & ID Number.Last Name,First Name-Student #
Yearbook 2019-2020:   $12.00   Quantity:   Item Subtotal:  
If ordering more than one yearbook, please place the students name which the books will be delivered to.
Ukulele Rental (Per Semester):   $10.00   Quantity:   Item Subtotal:  
Library Fine:   $   Item Subtotal:  
Donations:   $   Item Subtotal:  
Bus Fees are $100 for the first student and $50 for each additional student per year.
A Bus Agreement Form will also need to be completed.
Bus Fee:   $   Item Subtotal:  
Parent/Guardian Information
First Name: Last Name:
City: State/Province: ZIP/Postal Code:
Payment Information
Processing Fee Rates:
Cards: 3% plus $0.50 ($1.50 min)
(4.5% for foreign cards)
eCheck (ACH): $0.49
Name on Account:
Routing Number:
Account Number:
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

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