Authorize a One-Time Payment

1

It is best to sign into the Praxi Parent Portal and make a payment, rather than completing this form.

To use this form, the card you would like to use MUST be on file. Completing this form DOES NOT automatically charge the card, it only AUTHORIZES us to use the card on file.

2

Account Name * This field is required.Parent Name - See Pink Sheet for this name.

3

Student Name(s)* This field is required.

4

E-mail* This field is required.

To receive a copy of this submission, enter email address.

5

I received an INVOICE

Yes

No

6

Date to Process* This field is required.

Date

7

Amount to Process* This field is required.

8

Reason for Payment

Please give a brief description and reason for the payment.

9

Type of Card

Visa

MasterCard

Discover

10

Last 4 Digits on Card* This field is required.Card must already be on file with Zion.

Only the Last 4 Digits on the card

11

Zip Code

Address Postal ZIP Code (5 digits)

12

Signature* This field is required.My signature authorizes Zion Academy of America to process my payments as scheduled. I certify that I am the authorized cardholder, and I have full authority to make purchases on behalf of the account listed. I understand payments are non-refundable and non-transferrable. The information provided is accurate and complete.

13

I'm not a robot...* This field is required.