Card Card Authorization (one time only) Form - Atlanta's John Marshall Law School

One Time Authorization
I request and authorize Atlanta’s John Marshall Law School to charge my credit card according to the below information.
STUDENT'S Name*
Payment Description*
Semester*
Email*

to receive confirmation of form submission
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Address must be entered exactly as shown on your billing statement.
Credit Card Information
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Amount of Total Payment*
Signature
I authorize Atlanta’s John Marshall Law School to charge my credit card for the amount indicated above. I understand that there may be a 3-day period as to when my card may be charged due to business operating hours, school closings, etc. I understand that this is a one-time payment and this form will not be used to authorize any additional payments. Additionally, I understand that I am responsible for all payments not authorized or approved by my credit card company or bank. By signing below, I agree to the terms of this authorizations form.
Card Holder Signature*

Please type your name as your electronic signature.
Date*
MM slash DD slash YYYY
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One Time Authorization