Electronic Payment Questionnaire
To process your payment from the University of Rochester, please provide the following information.
Full Name (account holder)
*
First Name
Last Name
What's your email address (if you have a UR email, use that)
*
example@example.com
What's your phone number?
*
-
Country Code
-
Area Code
Phone Number
What is your residency status?
*
I'm a US citizen
I'm a US permanent resident
I'm a nonresident alien / not a US citizen or resident
Your mailing address
*
Street Address
Street Address Line 2
City
Country
Postal Code
Bank name
*
Bank account number
*
Bank routing number
*
Currency
*
Bank address
*
Street Address
Street Address Line 2
City
State, Province, or Country
Postal Code
Submit
Should be Empty: