CLASS Internet Payment Form

CLASS Internet Payment Form
For CLH (Formerly CLASS) accounts only (existing balances, fees, donations or extension quarters) Please do not use this form to enroll. Instead, you may enroll online at: homeschools.org.
FormID
IDprefix
RandomNum
FormIDcalc
Family or Student ID Number*
Billing Name*

First NameLast Name
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
In case we need to contact you about this transaction:
Phone Number
Email*
example@example.com
Is the billing address above the same as the CLASS family mailing address?*

YesNo
Family Name*

First NameLast Name
Family mailing address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please enter the amount you wish to apply to your balance.

Note: To add Extension Quarters please use the form at the bottom.
Pay My Bill
Please apply my payment toward: (Check all that apply)*

My Current BalanceTime Payment InstallmentShipping FeesChargeable Course FeesTranscript Fees (for requests already in process only)
Would you consider donating to our scholarship fund to help another family?

Not at this time$10.00$25.00$50.00Other Amount
Would you like to purchase Extension Quarters?

YesNo
Please Note: Only three extension quarters are allowed per any one grade level for a student. Extension quarters are added to the basic four quarters included in the basic tuition.
Student ID Number*
Student Name*

First NameLast Name
Extend Which Grade Levels?*

K123456789101112
Number of Extensions*

$35.00 (One quarter)$70.00 (Two Quarters)$105.00 (Three Quarters)
Extend Another Grade Level?

YesNo
Student ID*
Student Name*

First NameLast Name
Extend Which Grade Levels?*

K123456789101112
Number of Extensions*

$35.00 (One quarter)$70.00 (Two Quarters)$105.00 (Three Quarters)
Extend Another Grade Level?

YesNo
Student ID*
Student Name*

First NameLast Name
Extend Which Grade Levels?*

K123467859101112
Number of Extensions*

$35.00 (One quarter)$70.00 (Two Quarters)$105.00 (Three Quarters)
Extend Another Grade Level?

YesNo
Student ID*
Student Name*

First NameLast Name
Extend Which Grade Levels?*

K123467859101112
Number of Extensions*

$35.00 (One quarter)$70.00 (Two Quarters)$105.00 (Three Quarters)
Comments:
Form Total

Payment

USDTotal Payment

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty: