Earlham College - Acceptiva

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Congratulations on your decision to enroll at Earlham College! In order to hold your place in the class, complete the form below and submit your non-refundable $150 deposit.

If you have questions or are unable to submit your payment using this form, please contact the Office of Admissions at admissions@earlham.edu.

Qty

Description

Amount

Total

Confirmation Deposit

$150.00

Total: $150.00

Full Student Name: *

Earlham ID 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:

Use this space to include additional information, such as plans to defer enrollment to another semester or year.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *