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Tutor Doctor of Mansfield

Secure Payment Form

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Payment Date
Description
Payment Amount
Name on Card *
Card Billing Address *
Card Billing Zip Code *
Card Number *
Card Expiration Date *
CVV *
Name as on Check
Bank Routing Number
Bank Account Number
Student Name
Guardian's Name
Address
Address 2
City
State
Zip
Country
Phone Number
Email Address
By submitting this form, you confirm that all information entered for payment is correct and without error. Any error entered in this payment form that results in an incurred cost to Tutor Doctor will be the sole responsibility of the payee. Please make sure to confirm that you have entered all information without error to avoid any mischarges, declines etc.