CS Lewis - Fee Payments

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

Student name(s) required for delivery or pick up is also available.

Yearbook 2022-2023:

$16.00

Quantity:

Item Subtotal:

$0.00

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

Donations:

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% additional service fee for foreign cards)
eCheck:	$0.49

Method of Payment:	Credit/Debit Card eCheck
Update Name from Above

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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