Pay by credit card - ACA Summer

Credit Card Authorization and Payment Form

Credit Card Authorization and Payment Form

Student Name*
First Last
Invoice Amount to Charge:*
Name on Credit Card*
Credit Card Number*
Expiration Date*
MM/YY
Security Code*
Billing Email*
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card Authorization*
I agree to a 3.5% surcharge to cover the cost of credit card acceptance. The 3.5% fee is non-refundable and not-applicable towards final tuition. I authorize American Collegiate Collegiate Adventures, Inc. to charge the above listed bank card in the amount stated for my child's summer program tuition. I acknowledge that this payment is subject to the original contract terms and conditions, which I accepted at the time of initial application to American Collegiate Adventures, Inc.