Payment Authorization

We are excited to offer the safety, convenience and ease of Tuition Express- a payment processing system that allows secure, on-time tuition and fee payments to be made from either your bank account or credit card.

ELECTRONIC FUNDS TRANSFOR AUTHORIZATION FOR BANK ACCOUNT AND CREDIT CARD

COMPLETE ONE SECTION ONLY

SECTION A (Credit Card)

Note: A 3% processing fee will be added to all transactions paid with a credit or debit card

Cardholder Name:

Phone Number:

Cardholder Address:

Street Address Address Line 2 City State ZIP Code

Account Number:

Expiration Date:

Cardholder Signature:

Date:

SECTION B (Bank Account)

Your Name:

Phone Number:

Address:

Street Address Address Line 2 City State ZIP Code

Bank or Credit Union Name:

Bank or Credit Union Address:

Street Address Address Line 2 City State ZIP Code

Routing Transit Number:

Account Number:

Account Type:

Checking

Savings

Authorized Signature:

Date:

Payment Authorization

SECTION A (Credit Card)

SECTION B (Bank Account)

Shakopee

Savage

Bloomington

Excelsior

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