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CREDIT CARD PAYMENT FORM
From time to time students have a
problem with PayPal, so we have now provided a way to eliminate any
frustration.
We can charge your credit card from our office if you just fill in the
information below which sends us an e-mail with your
information. We can also send you a payable invoice from Google Check-Out we
just
need your name and e-mail address and the amount you want to pay you can use
the form below to do this. You will
then be directed thru the invoice to a secure payment page.
Or
You can use Google Check Out
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Please type your
name exactly as it appears on your credit card
First & Last name |
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Email Address
Phone Number
Street Address
City State Zip Code
Payment Amount
Card Type
Card Number
Expiration Date
Card Verification #
If the student name is different
then on the credit card add the student name here.
Student Name
We will contact you once the
payment has been successfully received. Or if we have a
problem.
 
American Express verification number
For Mastercard, Visa or Discover, the card
is on the front.
verification number is on the back. |
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You may type
additional comments here
Once you click the
submit button your information will be sent to us and you
will be directed back to the student page.
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