Customized Payment Authorization

Student Name(Required)
Parent/Guardian Name(Required)
Billing Address(Required)

Payment Terms: Payment for your Comprehensive Services Plan to take place in three installments of $2,500.00 on or about June 27, 2022, August 1, 2022 and September 1, 2022. (Per Linda Waters)
MC/VISA/AMEX/Discover
3 or 4 digits

Consent(Required)
This field is for validation purposes and should be left unchanged.