Fillable Uhhfeefrm (University of Hawaii at Hilo)

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Uhhfeefrm (University of Hawaii at Hilo)

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UNIVERSITY OF HAWAI`I AT HILO
Application Fee Form (Credit/Debit Card/Money Order)
CREDIT CARD INFORMATION (PLEASE COMPLETE THIS SECTION IF PAYING BY CREDIT CARD)
VisaMaster Card
Card Holder Signature
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.
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)
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 Business Office on campus.
Please fill in the appropriate information below:
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One
Permanent Address: Street City/Province State/Country Zip/Postal Code Phone (Mobile)
Current Mailing Address: Street City/Province State/Country Zip/Postal Code Phone (Home)
Spring
Legal Name: Family/Last First/Given Full Middle Any Other Names Used
Fall
Mailing address related to card: Street City/Province State/Country Zip/Postal Code
Card Type Card Number CVV2 Expiration Date
Date
Name (as printed on card)
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Uhhfeefrm (University of Hawaii at Hilo)

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Completed 22 July 2020

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