Uintah School - Students

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Vernal Middle School

Student Name & Lunch Number	Lastname	,	Firstname	-	SIS ID# (For help with your SIS Number call 435-781-3185)
Student Name & Lunch Number

Amount:

Item Subtotal:

$0.00

Total:

$0.00

Payer's Information:

First Name:		Last Name:
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*UINTAH SCHOOL DIS’ and the service fee transaction as ‘CBT*SVC FEE UINTAH SD’

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