Credit Card Form ARE YOU INTERESTED IN USING YOUR CREDIT CARD TO PAY YOUR INVOICE? IF SO, PLEASE COMPLETE THE FOLLOWING INFORMATION AND RETURN TO THE BUSINESS OFFICE University of Rio Grande Business Office PO Box 500 Rio Grande, OH 45674 740-245-7226 (Office) 740-245-7171 (Fax) PLEASE PRINT Student’s Name
ID#
Credit Card Holders Address Zip Code
Security Code
Please charge the amount of $
to my
American Express / Discover / MasterCard / Visa (Circle One) Card Number
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Expiration Date
Signature Required Date Signed Phone Number If you have any questions concerning the use of credit cards for paying Rio Grande Community College, University of Rio Grande or Graduate invoices, please call the Business Office at 740-245-7226. THE ABOVE INFORMATION IS CONFIDENTIAL.