Credit Card Payment Form

For your convenience, St. Johns Grammar School has a credit card payment system in place.  We ask that you complete the following information and return this with your registration packet.  Tuition balances are due on the first of each month.  Accounts that are 15 days past due will be charged with a late fee to your credit card.

Name of Student:  _______________________________________________

Name as it appears on the card: ____________________________________

Mastercard____     Visa_____     American Express_____ Exp. Date: _______

Credit Card Number: _____________________________________________

Signature: _____________________________________________________

Date: _______________________________

________ Yes, I would like to have my credit card automatically charged for the following:

Tuition_____                        Aftercare_____         Other_____

(Please indicate your preference by initialing all categories that apply)

Thank you,

SJGS Business Office