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SMS Payment Form 21-22
Please complete this Form for any payment for SMS.
Email address is collected so that a copy of this form can be emailed.
A 3% convenience fee will be charged for this transaction.
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* Indicates required question
Email
*
Your email
Student's LAST name:
*
Your answer
Student's FIRST name:
*
Your answer
What is payment for?
*
Select all that apply
$10 Chromebook usage fee due each year
Chromebook or charger fines (for damages or lost items)
GradVenture
Library book fines
TShirt Purchase
Other:
Parent/Guardian Name (This must match the name on the payment method.)
Your answer
Optional - Notes
(If you wish to include any additional information)
Your answer
PLEASE NOTE: You MUST click on the link in the Form Confirmation Message after you click SUBMIT, or you will NOT actually make a payment.
*
I understand I must click on the link to make payment. (Link will be on the screen once you click SUBMIT.)
Required
A copy of your responses will be emailed to the address you provided.
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