Online Payment Forms – Caribbean International Academy

Date*
MM slash DD slash YYYY
Name*
This agreement is between Caribbean International Academy (CIA) and Mr./Mrs.
First Last
Name*
for the authorization for CIA to debit Mr./Mrs.
First Last
Master/Visa card no.*
Card Exp Date:*
Name*
(Name of Student)
First Last
Year*
School year tuition,
$
for the total amount of USD.
Tuition
Tuition for the month(s)
$2
for the total amount of USD
$3
Tuition monthly charges of USD
from
from
to
to
$
Books for the total amount of USD
$
GRAND TOTAL AMOUNT USD TO BE CHARGED:
Parent Signature*
I agree and give my permission to charge my card.