Update Credit card

Please fill out this form if you have received a new Credit Card or wish to use a different Credit Card then the one we currently have on file. All information will remain confidential. Card will only be charged if you agree to auto-pay OR if you fail to submit payment by the 10th of the month. Even if you opt-out of auto-pay, we DO still need a credit card on file.

Beginning with our Summer Session 2023, we are utilizing a new student database management system called Jackrabbit. It allows you to set-up a Parent Portal, in which you have the ability to directly update any personal change of information and billing methods. We will be using that method to update credit cards come Summer.

Student's Name

Which student are we updating this Credit Card information for

Name on Credit Card

First Name

Last Name

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Credit Card Type

Credit Card Number

Please use dashes between every group of 4 numbers

Expiration Date

Card Identification Number

Last 3 digits located on the back of card

Authorization

Unless indicated that I will be paying by check or cash, I authorize Anastasis dba Radiance to charge the tuition and registration to the credit card provided herein. I agree to pay for this purchase in accordance with the issuing bank cardholder agreement. Should I need to withdraw from classes and suspend re-occuring monthly charges, I agree to give written notice of withdrawal by the 15th of the calendar month.

Acting Signature of Authorization

First Name

Last Name