Credit Card Payment Form

ADVERTISEMENT

Credit Card Payment Form
Did you know that you can pay your student account online? To process a
MasterCard, VISA or American Express payment, go to the Student Accounts link at
 Bring this completed payment form to the Student Accounts Office (2nd Floor of
the Mansion) or Mail it to Southern Vermont College, Student Accounts Office,
982 Mansion Drive, Bennington, VT 05201 or Fax it to (802) 447-6329.
Charge Type: American Express _______ MasterCard _______ VISA _______
I would like to pay for Tuition/Fees that have been billed to the student account listed
below. I am authorizing payment in the following amount of $______________.
Student’s Name: _________________________________________________
Student’s ID Number: _____________________________________________
Cardholder’s Name: _______________________________________________
Credit Card Number: ______________________________________________
Exp Date: ____________
Security Code: __________(on back of card)
Billing Address: ___________________________________Zip Code: _______
Daytime Phone #: _____________________
Cardholder’s Signature: _____________________________ Date: __________
For Office Use Only:
Semester: Fall _________ Spring __________ Summer __________
Date Received: _______________ Received/Processed By: ________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go