East Point Academy Payment Form
Secure Payment Form

 
Customer IP: 3.144.94.139 
           
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
 [What is the Card ID?]
Amount:
Please indicate what the payment is being used for(I.E. After School, Lunch, fees:) If paying for multiple items, please indicate amount for each item (I.E. Lunch $40.00, School Fees $100.00)
   
Billing Information:
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Phone Number:
Email Address: