Florida Vedic College

Registration/Tuition Payment Form

This Page is for the use of currently enrolled students only.

I am using this form to:
 Register for classes I wish to take and pay tuition.

 Make a tuition payment.
Last Name:     
First Name:   
Middle Initial:   
Social Security Number:
(if applicable)		   
Date of Birth:   
Address:   
Apt #:   
City:   
State:   
Country:   
Zip/Postal Code:   
Country Code:   
Telephone:   
E-mail:   
 

Use only if registering for classes:

I wish to take the following classes:
Class Name:    Number if known:   
Class Name:    Number if known:   
Class Name:    Number if known:   
Class Name:    Number if known:   
 
Payment Method:
Payment Amount (US$ Only)
 
For Credit Card Payment Only:
Account Holder Name:   
Account Number:   
Expiration Date:   
Address on Card:

  

If paying by personal or business check please use the following diagram as a guide:

Bank Information:  
Bank Name:   
Address:   
City:   
State:   
Zip Code:   
Phone Number:

  

Check Information:
Account Holder Name:   
Account Number:   
Check Date:   
Check Number:   
Check Amount:   
Transit Code:   
Routing Number:   
   

By choosing "I Agree" you authorize Florida Vedic College to draft your bank account for the amount shown on this form. You acknowledge that you are the owner or authorized signer on the account information entered in this form. Your order will be processed through your local bank as a normal check, and your account will never be accessed electronically. After you have entered the information, there is no need to send the check. Simply write the ordering information in your checkbook, just as if you had sent it in.

 
NOTE: All NSF returned checks will be subject to a $25.00 processing fee.

To Authorize Please Type "I Agree" Here: