Fillable Verifrequest.PDF ? (Las Positas College)

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Verifrequest.PDF ? (Las Positas College)

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Country of origin: US
File type: PDF

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TYPE OF PAYMENT:
VISA MASTERCARD
#:
EXP. DATE:
I authorized Las Positas College to charge my credit card for the following amount: $
Cardholder's Signature:
PRINT THIS FORM & SIGN.
Student's Signature: Date:
Date of Request:
Student ID or Social Security Number:
Name:
Other name or alias:
Street Address:
City, State, Zip:
Birthdate:
Phone:
NOTICE: Online payment is temporary down due
to upgrade. Please fill out this form for payment
and send it to :
LPC-Admissions@laspositascollege.edu
Your payment will be processed within 24 or 48
hours and admissions will mail a receipt to you.
Temporary Payment Option - Payment Form for Tuition
3000
Campus Hill Drive
Livermore, CA 94551
Tel: (925) 424-1500
Fax: (925) 606-6437
www.laspositascollege.edu/admissions
Office of Admissions and Records
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Verifrequest.PDF (Las Positas College)

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Completed 24 July 2020

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