Automated Payment Form

We are excited to offer the safety, convenience and ease of Tuition Express- a payment processing system that allows secure, on-time tuition and fee payments to be made from either your bank account or credit card.

ELECTRONIC FUNDS TRANSFOR AUTHORIZATION FOR BANK ACCOUNT AND CREDIT CARD

3% Processing Fee On ALL Credit/Debit Card Transactions

COMPLETE ONE SECTION ONLY

SECTION A (Credit Card)

Cardholder Name:

Phone Number:

Cardholder Address:

Street Address Address Line 2 City State ZIP Code

Account Number:

Expiration Date:

Cardholder Signature:

Date:

SECTION B (Bank Account)

Your Name:

Phone Number:

Address:

Street Address Address Line 2 City State ZIP Code

Bank or Credit Union Name:

Bank or Credit Union Address:

Street Address Address Line 2 City State ZIP Code

Routing Transit Number:

Account Number:

Account Type:

Checking

Savings

Authorized Signature:

Date:

Automated Payment Form

SECTION A (Credit Card)

SECTION B (Bank Account)

Greenville, RI

Smithfield, RI

Warwick, RI

Have Questions?