BRIDGES ACADEMY PAYMENT FORM
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
Confirmation Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
Your Payment
Purpose of Payment
*
Please Select
Temporary Seat Hold ($4,000)
Senior Trip - Palm Springs ($1,400)
Yearbook Ad - Full ($250) - 12th grade only
Yearbook Ad - Half ($175) - 12th grade only
Yearbook Ad - Quarter ($120) - 12th grade only
Annual Fund
Bridges Academy LA
Bridges Academy Online
Catalina Trip
Bridges 2e Center
Other
Description
*
Name of student, event, or subject this payment pertains to
Payment Amount
*
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USD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
SUBMIT
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