Payment Form

Student's Information:                                       * Required

Student's First Name:*:
Student's Middle Name:
Student's Last Name*:  
Students School ID #:

Bill Payer's Information:

First Name:*:
Last Name*:
Address*:
City*:
State*:
ZIP:*:
Phone Number :   xxx-xxx-xxxx
Email Address:
Payment Description:  
Payment Amount*: $      +Convenience Fee  2 %
= Total:  

To finish your order, choose a payment method & click on the button below:

Payment by Check Payment by Credit Card