Today's Date   Student's Name 

        

PLEASE ENTER THE FOLLOWING INFORMATION:

 Methods of Payment:

An applicant who has registered for any course, program, or workshop may use the following methods of payment;

1. 100% of the total balance due at registration.

2. 50% of the total balance due at registration and the balance due in four weeks.   

 
Please provide your authorization by entering the payment amount and dates payments are to be made.

If you are paying for your course or program in full, please enter the payment amount and date ( Month/ Day/Two Digit Year).

Payment Amount/Date                

  If you are making partial payments please enter the three payment amounts and dates               ( Month/ Day/Two Digit Year). All payments must be made within four weeks a part.

Payment Amount/Date                                                 

Payment Amount/Date                

Payment Amount/Date                   

 

You may select the payment method, listed below.

 

I prefer to pay by Credit or Debit Card.   

Type or Card ( Example; MasterCard, Visa, or American Express)

My Debit Card Number is                   Expiration Date   

My Credit Card Number is                  Expiration Date       

Three Digit Security Code   ( Located on the back or the front of your credit or debit card)

Name of Financial Institution                                       

Name as it appears on Debit Card or Credit Card     

Address as it appears on  Debit or Credit Card          

Use of Debit or Credit Card:  The debit card or credit card on file will be used as a method of payment. If you are making two partial payments, we will notify you in advance of making the last charge to the card on file. You may then specify if your would like to use another type of payment.

 I certify that I have read, understand, and agree with the " Use of Debit or Credit Card" statement.

  I certify that I am the authorized user of this debit or credit card. I also agree that I will be responsible for any unauthorized use and held responsible for any balances due after registration.

This is a secure site.  However, if you do not feel secure providing this information on line, please call us @ (708)720-4547 or (866)720-4547.

  

                                                            

 

 Accountax School of Business
2012 All rights reserved.
Revised: 06/21/17