Payment Form
*Student Name: 
*School: 
*Billing Address: 
*Billing City: 
*Billing State: 
*Billing Zip: 
*Phone:    [ex.  (123) 456-7890]
*Email: 
*Order Type: 
Order Date:    if known  [ex.  MM/DD/YYYY]
Comments: 
* Must enter name, school, billing address, billing city, billing state, billing zip, AND either phone or email address.
*Amount:    no dollar signs  [ex.  125.00 or 125 or 125.14]
*Credit Card: 
*Number:    no hyphens  [ex.  12345678901234567]
*CVV:    What's this?
*Expiration:   / 
*Name on Card: 
* Must enter all information about your credit card.
To submit your payment, click 'Submit'. After clicking 'Submit' you will receive a printer-friendly summary of the information you sent to Balfour. To cancel your payment, click 'Cancel'.
 
Make sure your browser has a lock similar to this one before submitting your credit card information!