P e r a l t a C o m m u n i t y C o l l e g e D i s t r i c t
Berkeley City College | College of Alameda | Laney College | Merritt College
Office of International Education • 333 East 8
th
Street, Oakland, CA 94606
Tel. (510) 466-7380 • Fax (510) 465-3257 • Email international@peralta.edu
www.peralta.edu • https://web.peralta.edu/international
Credit Card Payment Form
Please complete this form and submit to the international office.
A. STUDENT INFORMATION:
Date (mm/dd/yy): Student Name:
Amount: Peralta Student ID:
Please select the semester & year for this payment: term at: Spring
Summer Fall
Select your campus:
Berkeley City College College of Alameda Laney College Merritt College
B. CREDIT CARD HOLDER INFORMATION):
Name on Card:
Credit Card Number: Last 3 Digits:
Credit Card: VISA Discover MasterCard Expiration (mm/yy):
Address: Apt No.:
Address Cont: Country:
Phone: Email:
Comments/Other:
Payment For:
Application Fee ($50)
Other:
