Credit Card Authorization Credit Card Authorization One of the ways that you can pay your child's tuition is by Credit Card through Tuition Express. This form gives the school authorization to charge your card each month for your child's tuition. Please contact email@example.com if you have any questions. I hereby authorize Bellevue Montessori School, "BMS", to initiate by below-referenced credit card account, contracted tuition (including Activity Club) fees.*This authorization is to remain in full force and effect until all obligations to BMS have been paid or until BMS has received written notification from me of it's termination as such time and in such a manner as to afford BMS a reasonable opportunity to act on it. A convenience fee based on approximately 3.2% of your child's monthly tuition (see fees below) is automatically added to payments made through a credit card. Tuition and fee payments will be initiated automatically on the first of each month.Credit Card fees by Program* Toddler Primary (Early Childhood/Kindergarten) Elementary Please select your child's program to see the exact amount of the approximate 3.2% convenience fee that will be charged in addition to your tuition.Toddler Tuition Convenience Fees Toddler Half Day tuition $1325.00, Convenience Fee - $43.00 Toddler School Day tuition $1695.00, Convenience Fee $55.00 Toddler Full Day Montessori tuition $2060.00. Convenience Fee $66.00 Below are the convenience fees for the various Toddler Tuitions.Primary Tuition Convenience Fees Primary Half Day Tuition $1115.00 - Half Day convenience fee $36.00 Primary School Day Tuition $1500.00 - School Day convenience fee $48.00 Full Care Tuition $$1910 - Full Care convenience fee - $62.00 Above is the convenience fees for the various Primary (Early Childhood/Kindergarten) program tuition.Elementary Tuition Convenience Fee LE School Day tuition - $1680. Convenience fee of $54.00 LE School Day with AC tuition - $2090. Convenience fee of $67.00 UEL School Day tuition - $1705. Convenience fee of $55.00 UEL School Day with AC tuition - $2115. Convenience fee is $68.00 Cardholder Name* First Last Cardholder Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Cardholder Phone*Credit Card Number*Expiration Date*Child's / Children's NameCardholders Signature*Date This iframe contains the logic required to handle Ajax powered Gravity Forms.