CS Lewis - Fee Payments
             
Student's Name & ID Number.Last Name,First Name-Student #
 
Softback Yearbook:   $12.00   Select:   Item Subtotal:  
$0.00
Hardbound Yearbook:   $17.00   Select:   Item Subtotal:  
$0.00
Ukulele Rental (Per Semester):   $10.00   Quantity:   Item Subtotal:  
$0.00
Library Fine:   $   Item Subtotal:  
$0.00
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
Method of Payment:
Processing Fees: Credit cards: 3% plus $0.50 ($1.50 min)
                    (+1.5% processing fee for foreign cards)
eChecks: $0.49
Update name from Parent/Guardian 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 Parent/Guardian 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

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