Delta Technical Center

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Delta Technical Center

Student Name	Lastname	,	Firstname
Student Name

2nd CTSO:

$5.00

Quantity:

Item Subtotal:

$0.00

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FFA Day Trip:

$5.00

Quantity:

Item Subtotal:

$0.00

FFA Monthly Floral Arrangement:

$15.00

Quantity:

Item Subtotal:

$0.00

FFA Jacket and Tie/Scarf:

$80.00

Quantity:

Item Subtotal:

$0.00

FFA Tshirt:

$10.00

Quantity:

Item Subtotal:

$0.00

FFA Long Sleeve Shirt:

$15.00

Quantity:

Item Subtotal:

$0.00

FFA Sweatshirt:

$30.00

Quantity:

Item Subtotal:

$0.00

Safety Glasses:

Item Subtotal:

$0.00

Welding Gloves:

Item Subtotal:

$0.00

Metal Bill:

Item Subtotal:

$0.00

Wood Bill:

Item Subtotal:

$0.00

Night Classes:

Item Subtotal:

$0.00

Misc:

Item Subtotal:

$0.00

FBLA Membership:

$20.00

Select:

Item Subtotal:

$0.00

FFA Membership:

$20.00

Select:

Item Subtotal:

$0.00

HOSA Membership:

$20.00

Select:

Item Subtotal:

$0.00

SkillsUSA Membership:

$20.00

Select:

Item Subtotal:

$0.00

TSA Membership:

$15.00

Select:

Item Subtotal:

$0.00

Total:

$0.00

Parent's 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:	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*MILLARD SCHOOL DI’ and the service fee transaction as ‘CBT*SVC FEE MILLARD S’

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