Wiley University - Acceptiva

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

If you have any questions or concerns regarding your payments, please contact Amia Richardson, Students Accounts Receivable at 903.927.3207 or amcjones@wileyc.edu

Qty

Description

Amount

Total

Soccer Fee

$150.00

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Total: $0.00

Student Name: *

Student ID number: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Point of Contact E-mail: *

A receipt will be e-mailed to this address.

Point of Contact Mobile: *

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *