Payment

Please Note: Center for Allied Health Education (CAHE) is firmly committed to assisting students who are facing financial challenges due to the COVID-19 pandemic. Effective immediately, CAHE will be waiving credit card fees for all payments made during the month of April and May 2020.

Payment Amount $ *

Credit Card    Check
 

Total Amount Being Charged $

Personal Information

Student Name: *

Program *

-- Select One -- Diagnostic Medical Sonography EMT/Paramedic (Full-Time) Paramedic Refresher Medical Assistant Radiography Radiation Therapy Surgical Technology > CT Registry Prep MRI Registry Prep

Address: *

City: *

State: *

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Zip Code: *

Country: *

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Phone Number: *

Cell Phone:

Email Address: *

Payment Details

Account Name

Account Type *

-- Select One -- Checking Savings

Routing Number *

Re-enter Routing Number *

Account Number *

Re-enter Account Number *

By authorizing this transaction, customer agrees that merchant may convert this transaction into an Electronic Funds Transfer (EFT) transaction or paper draft, and to debit this account for the amount of the transaction. Additionally, in the event this draft or EFT is returned unpaid, a service fee, as allowable by law, will be charged to this account via EFT or draft. In the event that I choose to revoke this authorization, I will do so by contacting the merchant directly. Processing times may not allow for revocation of this authorization. Processing electronic check payment using insufficient funds or incorrect account information, will result in a fee of .05% of the total amount, if it doesn't exceed $7,499. The fee of 0.1% will be incurred for payments over $7,500. *

First Name: *

Last Name: *

Card Type: *

Visa Mastercard American Express

Card Number: *

Exp. Month: *

-- Select One-- 01-January 02-February 03-March 04-April 05-May 06-June 07-July 08-August 09-September 10-October 11-November 12-December

Exp. Year: *

-- Select One-- 2020202120222023202420252026202720282029

Security Code: *

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