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Housing Deposit Payment Form
 

Payments

Housing Deposit ($500.00)

Full Name:


E-mail Address:


Student Name:


Credit Card Type:


Credit Card Number:


Expiration Date (mm/yyyy):


Name (Exactly as it appears on card):


Address (must be the same as the billing address for the card):


City:


State:


Postal Code:


Daytime Phone Number:


By submitting this form electronically, you agree to a charge of $500.00 (in US currency) for the housing deposit for Seagle Music Colony.