CS Lewis - Fee Payments

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Student's Name & ID Number.	Last Name	,	First Name	-	Student #
Student's Name & ID Number.

Yearbook 2020-2021:

$10.00

Quantity:

Item Subtotal:

$0.00

If purchasing more than 1 yearbook,
Please type other student names

Donations:

Item Subtotal:

$0.00

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:

$0.00

Total:

$0.00

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:
Update Name from Personal/Organizational Information

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*CS LEWIS ACADEMY’ and the service fee transaction as ‘CBT*SVC FEE CS LEWIS’

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