Credit Card Payment Form

First Name

Last Name

Student ID#:

E-mail

Amount of Payment:

Credit Card Type (PLEASE CHOOSE ONE):

Credit Card Number:

Expiration Date of Card (PLEASE SELECT):

Month:   Year:   

CIV Number (3-digit security code on the back of the card):

Name as It Appears on the Card:

Billing Address of the Credit Card:

City:

State:

Zip:

If this payment is for charges not already posted to your Trinity account, please note what the payment is for.