Payment Page

Student Name*
First Middle Last Suffix
Invoice #*
Cardholder Name*
First Middle Last Suffix
Cardholder Email*
Enter Email Confirm Email
Cardholder Cell Phone*
Please enter the payment amount as discussed with One-on-One College Consulting below:
Payment Amount*
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Parent/Guardian Signature
I authorize One-on-One College Consulting to charge my credit card for future payment plan installments (if applicable).
Cardholder Electronic Signature*
Comments
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