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Bushnell University

Secure Payment Form

*** DEBIT CARD PAYMENTS ONLY ***

To pay by credit card please click your

browser's back button or return to

www.bushnell.edu/paymybill

and select Pay by Credit Card

Student ID #
First Name
Last Name
This payment is for:
Today's Date
Payment Amount
Add to School Database?
Enable Automatic Payments?
Schedule of Automatic Payment
Total Number of Automatic Payments
Date of Next Automatic Payment
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Email Address (Required for your receipt)
Phone Number