Fillable ApplicationFeeForm Application Fee Form (Credit/Debit Card/Money Order)

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ApplicationFeeForm Application Fee Form (Credit/Debit Card/Money Order)

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Country of origin: US
File type: PDF

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UNIVERSITY OF HAWAI`I HILO
Application Fee Form (Credit/Debit Card/Money Order)
Fall
Spring
Legal Name: Family/Last First/Given Full Middle Any Other Names Used
Current Mailing Address: Street City/Province State/Country Zip/Postal Code Phone (Home)
Permanent Address: Street City/Province State/Country Zip/Postal Code Phone (Mobile)
Please fill in the appropriate information below:
Choose
One
Money Order or Check (attach check or money order drawn from a US Bank and submit form)
Credit Card (complete credit card information below and submit form)
CREDIT CARD INFORMATION (PLEASE COMPLETE THIS SECTION IF PAYING BY CREDIT CARD)
Name (as printed on card)
Mailing address related to card: Street City/Province State/Country Zip/Postal Code
Card Type Card Number CVV2 Expiration Date
Master Card Visa
Agreement: I agree to pay $50.00 (U.S.) according to the card issuer agreement. By signing the payment authorization form,
I acknowledge that the fee is non-refundable and non-transferable.
Card Holder Signature Date
Form Submission:
Mail the original to:
UH Hilo Admissions Office
200 West Kawili Street
Hilo,Hawai`i 96720.
OR
Fax the form to: UH Hilo Admissions Office at 1-808-932-7459
OR
Cash payments can only be made by visiting the Cashier's Office on campus.
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ApplicationFeeForm Application Fee Form (CreditDebit CardMoney Order)

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Completed 2 March 2020

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