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Spirit Wear
Student's Full Name
JA Beanie:
$12.00
Quantity:
Item Subtotal:
$0.00
New JA Crew:
$14.00
Quantity:
Item Subtotal:
$0.00
JA Flat Brim:
$12.00
Quantity:
Item Subtotal:
$0.00
New JA Hoodie:
$18.00
Quantity:
Item Subtotal:
$0.00
New JA T-Shirts:
$10.00
Quantity:
Item Subtotal:
$0.00
JA Water Bottle:
$5.00
Quantity:
Item Subtotal:
$0.00
Old JA Swag:
$5.00
Quantity:
Item Subtotal:
$0.00
Total:
$0.00
Contact 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)
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:
Payment method will be collected on external device
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CORE Payments Version 5.0.167; (API: 2.22)
