|
|
|
Payment Transaction Information:
|
|
Customer IP:
|
216.73.216.155
|
|
Payment Date:
|
10/29/25
|
| Payment Number: |
|
|
Student(s) to apply payment for:
|
|
| Receipt Email Address: |
|
| Payment Amount: |
|
| Service Fee (2%): | |
| Total Charge: |
|
|
Type:
|
|
|
|
|
|
Recurring Information:
|
|
Frequency:
|
|
|
Start Date:
|
YYYYMMDD
|
Number of payments:
(Max of 9 remaining payments)
|
|
|
|
|
Credit Card Information:
|
|
|
|
Card Type:
|
|
|
Name as on Card:
|
|
|
First Name:
|
|
|
Last Name:
|
|
|
Card Billing Address:
|
|
|
Card Billing City:
|
|
|
Card Billing State:
|
|
|
Card Billing Zipcode:
|
|
|
Card Number:
|
|
|
Card Expiration Date:
|
MMYY
|
Card ID (CVV2/CID) Number:
[What is the Card ID?]
|
|
|
|
|
Refund Policy: All payments are non-refundable and non-transferable. |
I authorize Faith Lutheran Preschool to initiate an ACH/credit transaction in the amount referenced. I affirm the transaction I authorize comply with all applicable laws.
|
|