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EZPAY OPTIONS
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credit card
CREDIT OR CHECK CARD PAYMENTS
Complete the information in each section.
CARD HOLDER INFORMATION
First Name
Last Name
Email
Address
City
State
Zip
Phone Number
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Credit or Check Card Type
Card Number (no spaces/hyphens)
Visa
MasterCard
American Express
Discover
Expiration Month /Year
Payment Amount
01
02
03
04
05
06
07
08
09
10
11
12
2007
2008
2009
2010
2011
2012
2013
2014
2015
$
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STUDENT INFORMATION
First Name
Last Name
INVOICE NUMBER
If you
DO NOT
have an invoice number, do not change the number fields (leave as 0000000-000). If you
DO HAVE
an invoice number, it must be entered as a 7-digit value followed by a 3-digit value. Use leading zeros as needed.
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