Credit Card Payment Form

ACE Credit Card Payment Form

Student’s Name __________________________________

Name of Class ___________________________________

High School _____________________________________

Card:

□ MasterCard

□ Visa

□ Discover

Name on Card _____________________________________________

Card Number ______________________________________________

Expiration Date ______/_______

Month Year

Security Code from Back of Card (3 digits) ____________

I authorize the charge for this class to the credit card above

____________________________________________

____________

Signature of Cardholder

Date

Please print, complete form, and submit to the ACE Office

By mail: ACE Office, Westcehster CC, 75 Grasslands Rd, Valhalla NY 10595

By fax: 914-606-6129

By email: scan completed form and email to ace@sunywcc.edu

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Parent category: Financial