Credit Card Payment Form - College of Saint Rose



The College of Saint RoseAccepted StudentsCredit Card Payment FormCongratulations on your acceptance and decision to attend The College of Saint Rose! To process a Discover, MasterCard, VISA, or ACH (WebCheck) payment, log into your student account at may also use this form to pay and Enrollment Deposit for tuition, room and/or board by credit card.In Person: Undergraduate Admissions Office at 1001 Madison Avenue, Albany, NY 12203 (Scanlon Hall)By Mail: The College of Saint Rose, Undergraduate Admissions Office, 432 Western Ave. Albany, NY 12203Via Fax: 518-454-2013Note: For security purposes, please do not scan and email this completed form.If you have any questions, please call the Undergraduate Admissions Office at 518-454-5150Credit Card Type: Discover _______ MasterCard _______ VISA _______Please check the appropriate option(s):____ I would like to pay the Enrollment Deposit & Room and Board ($300)*____ I would like to pay the Enrollment Deposit ($150)*Student’s Name: ______________________________________________________Student’s ID Number: __________________________________________________Cardholder’s Name: ___________________________________________________Credit Card Number: _________________________________ Exp Date: ________Billing Street #: _______________________ Zip Code: _______________________Daytime Phone #: ____________________________________________________Cardholder’s Signature: _______________________________ Date: ___________For Office Use Only:Semester: Fall _________ Spring __________ Summer 1 __________ Summer 2 __________Date Received: _______________ Received/Processed By: ________________ ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download