Credit Card Checkout | CASDA

PAYMENT FORM

Name *

First

Last

Student Name

Please enter if different than payee name

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Available Items *

PAYMENT IN FULL - $3,800 today
DOWN PAYMENT [$3,395 due prior to first class] - $500 today
PAYMENT PLAN [3 other payments of $1000] - $995 today
OTHER AMOUNT [fill in line below]

Total

$ 0.00

Stripe Credit Card *

Card

Name on Card

Captcha *

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