Diversity Coalition Payments

Student Information:

First Name:

Last Name:

Student ID (9 digit numeric):

Payment Amount ($):

ie: 18.93

Please provide the name of the event of product being purchased:

# = Numbers [0-9], * = Required

Accounting Office | 401 Rosemont Ave. Frederick, Maryland 21701 | (301) 696-3607

Payments For: Diversity Coalition

Cardholder Billing Information:

First Name:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Country:

Phone Number:

Email Address:

Payment Information:

Amount for Payment:

Credit Card Number:

Card Verification Code:

Expiration Month:

Expiration Year:

# = Number [0-9] * = Required Fields

Please click "Complete Payment" only once to avoid having multiple transactions charged to your card. Processing may take several minutes

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Accounting Office | 401 Rosemont Ave. Frederick, Maryland 21701 | (301) 696-3607