The College Of Saint Rose Credit Card Payment Form printable pdf download

The College of Saint Rose

Credit Card Payment Form

Did you know that you can pay your student account online? To process a Discover, MasterCard, VISA, or

ACH (WebCheck) payment, log into your student account at https://bannerweb.strose.edu.

You may use this form to pay tuition, room, board and/or miscellaneous fees that have been billed to your

student account. You may also authorize a payment to increase your Golden Knights Kash balance.

In Person:

Bring this payment form to the Student Solution Center (Saint Joseph Hall, 3

Floor)

By Mail:

Mail form to: The College of Saint Rose, Bursar’s Office, 432 Western Ave. Albany, NY 12203

Fax:

Fax form to: 518-454-2054

Note: For security purposes, please do not scan and email this completed form.

If you have any questions, please call the Bursar’s Office at 518-458-5464.

Credit Card Type:

Discover _______

MasterCard _______

VISA _______

Please check the appropriate option(s):

_____ I am authorizing payment for tuition, room, board and/or fees which have been billed to the account

of the student listed below. Please process payment in the amount of $______________

_____ I am authorizing payment in order to increase the Golden Knights Kash balance for the student

listed below. Please process payment in the amount of $________________

Student’s Name: ______________________________________________________

Student’s ID Number: __________________________________________________

Cardholder’s Name: ___________________________________________________

Credit Card Number: _________________________________ Exp Date: ________

Billing Street #: _______________________ Zip Code: _______________________

Daytime Phone #: ____________________________________________________

Cardholder’s Signature: _______________________________ Date: ___________

For Office Use Only:

Semester: Fall _________ Spring __________ Summer 1 __________ Summer 2 __________

Date Received: _______________ Received/Processed By: ________________

7/20/2015

The College Of Saint Rose Credit Card Payment Form