Online Payment Form

Accepted forms of payment are Visa and Mastercard. Wire transfers and electronic checks are not currently accepted. Depending on your financial institution, your payment may take 1-2 business days to post to your account, however the day the transaction was made will be honored. After you submit this form, you should receive an email confirmation with a copy of the payment. It is recommended you keep this for your records. If you have any questions or concerns regarding payments, please contact the financial department at finance@atlanticseminary.org. Fields marked with * are required.

Name *

First

Middle

Last

Please provide the name that appears on your registration, if it is different from your present name.

Student I.D. Number

If unknown, you may leave blank.

Name as it appears on card, if different from above.

First

Last

Card Type *

Expiration Date *

Amount *

International students, please use this link for current exchange rates: https://www.x-rates.com/calculator/

Reason for Payment (check all that apply) *

Email *

Phone Number *

Billing Street Address *

City *

State or Province *

Country

Zip code or Country code *

Payment Authorization *

By checking this box, you certify that the information entered on this form is correct, and you authorize Atlantic Coast to make a non-refundable, one-time charge in the above amount to the credit or debit card number entered on this form. Transactions may not be available for cancellation after the payment is submitted. Fees are non-refundable.

Today's Date *

Month/Day/Year