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Excelsior Academy
124 E. Erda Way - Erda, UT 84074
(435) 882-3062
Event
Lost Books/Library Fines
Library Fine:
$
Item Subtotal:
$0.00
Student's Name
Lost Book:
$
Item Subtotal:
$0.00
Student's Name
Miscellaneous
Carpool tags:
$1.00
Quantity:
Item Subtotal:
$0.00
Dockets:
$10.00
Quantity:
Item Subtotal:
$0.00
Middle School Keeper:
$15.00
Quantity:
Item Subtotal:
$0.00
Lion's Pride T-shirt(s):
$6.00
Quantity:
Item Subtotal:
$0.00
Lion's Pride Sweatshirt Youth size (XS - L):
$12.00
Quantity:
Item Subtotal:
$0.00
Lion's Pride Sweatshirt Adult Size (S - 4X):
$15.00
Quantity:
Item Subtotal:
$0.00
Plant Sales amount:
$
Item Subtotal:
$0.00
Dance Concert:
$5.00
Quantity:
Item Subtotal:
$0.00
Miscellaneous:
$
Item Subtotal:
$0.00
Friends of Excelsior
Donation Amount:
$
Item Subtotal:
$0.00
Total:
$0.00
Payers 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)
(4.5% for foreign cards)
eCheck (ACH):
$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:
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SIP Version 3.05.14365; (API: 2.17)
