Payments – Student Enrollment

School Location*
Student ID
Student Name*
First Last
Registration
Tuition and other
Maximum amount is $5,000
Total
Price: $0.00
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Who is your Student Service Representative?*
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Note* Do not submit payment twice to prevent duplicate charges.