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General Information

* First Name

* Last Name

* Account Number

* Payment Reason

* Payment Amount

Billing Information

* Card Number

We accept VISA, Mastercard, American Express, and Discover

* Card Expiration Date

Month Year

* Card Security Code

* Name On Card

* Billing Street Address

* Billing Address City

* Billing Address State

* Billing Address ZIP

* Billing Email Address

* Billing Phone Number

Payment Agreement

You authorize the University of Evansville to initiate a charge to the above specified credit or check card. Your credit or check card statement will reference "U OF E BUSINESS OFF" as the payee. You affirm that:

I have read, understand and agree to be bound to the terms of this agreement;
I am authorized to perform transactions using the card information above;
I accept the terms of this agreement and certify, under penalty of law, that the information provided above is correct.

Should this transaction fail for any reason (including invalid account numbers, chargeback etc.) you understand that additional penalties, fees and interest may accrue.