Payment Authorization for SAGE Scholars Program Your Name(Required) First Last Email(Required) Mobile #(Required) Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Which SAGE Program?(Required)SAGE Basic - $79 billed monthlySAGE Max - $119 billed monthlySAGE Basic - $869 billed annually (save $79)SAGE Max - $1,309 billed annually (save $119)Choose your planCard Account Number(Required) MC/VISA/AMEX/DiscoverCVV Code(Required) 3 or 4 digitsExp Date (mm/yy)(Required) Disclosure and Advisor Consent(Required) Strategies For College Inc. administers the SAGE Scholars Tuition Rewards Program for The Vermont Agency, Northern New England Agency and NPA Financial. By completing this form, I agree that Strategies For College, Inc. may bill my credit card for the SAGE plan indicated above.Signature(Required)EmailThis field is for validation purposes and should be left unchanged.