Earlham College - Acceptiva

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Congratulations on your decision to enroll at Earlham! In order to hold your place in the class, complete the form below and submit your non-refundable $150 deposit within 15 days of your admit date for first-year students, or June 15 for transfer students (unless prior arrangements have been made for an extension).

If you have questions or are not able to submit your payment using this form, please contact the Office of Admissions at admissions@earlham.edu for other payment options.

Qty

Description

Amount

Total

Confirmation Deposit

$150.00

Total: $150.00

Full Student Name: *

Identification Number: *

(This number can be found in your acceptance letter. Contact the Admissions office with questions.)

Date of Birth: *

MM/DD/YYYY

Payer Details

First Name: *

Last Name: *

Billing Address: *

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

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Notes:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *