Online Payment

Online Payment Form

Dental Assisting Academy of the Palm Beaches Online Payment Form. You will be redirected to the PayPal Website to complete the online payment submission. You DO NOT need a PayPal Account, you can continue as a guest on the site. If you have a question about the amount due on the student's account please call or text us at 561.900.7141
Full Name of Student *

First Name Last Name
Name of Person Paying *

First Name Last Name
E-mail for receipt *
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Class Payment *

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USD Using the blank white box above, enter the amount that is due on the student account.
Should be Empty:

Online Payment Form