High-School Dual Enrollment Payment - St. Thomas University

Name

First Name

Last Name

Student's Email

High School

Cardholder's Name

First Name

Cardholder's Last Name

Last Name

Cardholder's Email

Cardholder's Phone

Optional

Cardholder's Address

Street Address

Street Address continued (optional)

City

State/Province

Zip/Postal

Country

Cardholder's Address

Payment Amount

$USD

Payment Memo

Optional

Payment Card Details

Acknowledgement 1

I understand the billing credit card I have provided will be immediately charged for the amount listed in the field labeled "Payment Amount".

Acknowledgement 2

I understand a $25.00 fee will be charged to research a disputed web payments.

Acknowledgement 3

I understand payments made after 3:00 PM will be credited the next business day.

High-School Dual Enrollment Payment Form