Remember to put your own text here (same as alt text)Please print and complete the form below and return it to Student Accounts/Cashiers Services to authorize payment by credit card for your open balance.
Mail form to:
California State Polytechnic University, Pomona
Student Accounting & Cashiering Services
3801 West Temple Avenue
Pomona, CA 91768
Student ID ______________________________________________
Amount $ _______________________________________________
Student Name ___________________________________________
Credit Card Number ______________________________________
Expiration Date (MM/YY __________________________________
Credit Card Signature _____________________________________
Telephone Number _______________________________________
