Children's Formation and Youth Ministry Payment Form

Payment Amount / Cantidad a pagar

Family Name / Apellido de la Familia *

Cell Phone Number/ Numero de Celular *

Student Name (s)/ Nombre de Estudiante (s) *

Notes (program or event) / Notas ( Programa o Evento)

There is a fee for making payments online or over the telephone with a staff member of St. Timothy's. *

Current Total:

0.00

*** Please note: There is a $3.00 surcharge fee when using Paypal.

Using a payment method over the phone requires the payee to accept the following conditions:

A St. Timothy Catholic Church staff member will not complete any payment without verbal consent to proceed with the payment in the exact amount authorized by the payee.
The payee will provide his/her card information over the phone to complete the transaction.
The payee will receive a confirmation email that the payment was made successfully.
Payments go directly to St. Timothy Catholic Church Parish Paypal Account.
No record of credit/debit card numbers will be retained for future use by St. Timothy Catholic Church.
Payments are never recurrent. The payee must contact a St. Timothy staff member for each future payment and agree to the conditions outlined above for each payment.

By my signature below, I agree with the statements above and give St. Timothy's permission to proceed with my payment via telephone.

Signature *

clear

$200 Payment	$100 Payment	$50 Payment	$40 Payment
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