Faith Lutheran Preschool Tuition Payment Form


Payment Transaction Information:
Customer IP:	3.235.176.80
Payment Date:	05/20/22
Payment Number:
Student(s) to apply payment for:
Receipt Email Address:

Payment Amount:
Service Fee (2%):
Total Charge:

Credit Card Information:
Card Type:
Name as on Card:
First Name:
Last Name:
Card Billing Street 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.