CREDIT CARD FORM (Visa, Mastercard, or Discover)

 

If you wish to pay your fees by credit card, fill out this form or the form included with your student billing statement.  Return this form to the University Cashier’s Office, WH B-270  either in person or by mail.

 

I understand that if my payment is received after the payment deadline, all amounts due, including applicable late fees, will be charged to may credit card account.

 

 

Name:

 

 

Student ID No./Soc.Sec. No.:                                                                             Daytime Phone No.

 

 

Credit Card Number:                                                                                            Expiration Date:

 

 

Authorized amount not to exceed $                                  plus applicable late payment/registration fees.

 

 

Signature: