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Payment Transaction Information:
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Customer IP:
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18.97.14.84
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Payment Date:
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12/11/24
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| Payment Number: |
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Student(s) to apply payment for:
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| Receipt Email Address: |
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| Payment Amount: |
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| Service Fee (2%): | |
| Total Charge: |
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Type:
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Recurring Information:
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Frequency:
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Start Date:
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YYYYMMDD
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Number of payments:
(Max of 9 remaining payments)
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Credit Card Information:
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Card Type:
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Name as on Card:
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First Name:
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Last Name:
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Card Billing Address:
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Card Billing City:
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Card Billing State:
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Card Billing Zipcode:
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Card Number:
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Card Expiration Date:
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MMYY
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Card ID (CVV2/CID) Number:
[What is the Card ID?]
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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.
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