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  • Credit Card Payment Form: University of Minnesota Libraries

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    This document is a credit card payment form for the University of Minnesota Libraries. It requests the cardholder's name, student ID number, phone number, credit card number, expiration date, card type, payment amount, signature, and date. The completed form should be returned to the Borrowing Privileges & Fines office address or faxed number provided so the payment can be processed and credited.

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    This document is a credit card payment form for the University of Minnesota Libraries. It requests the cardholder's name, student ID number, phone number, credit card number, expiration date, card type, payment amount, signature, and date. The completed form should be returned to the Borrowing Privileges & Fines office address or faxed number provided so the payment can be processed and credited.

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    © All Rights Reserved
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    4 views1 page

    Credit Card Payment Form: University of Minnesota Libraries

    Uploaded by

    Musamune
    This document is a credit card payment form for the University of Minnesota Libraries. It requests the cardholder's name, student ID number, phone number, credit card number, expiration date, card type, payment amount, signature, and date. The completed form should be returned to the Borrowing Privileges & Fines office address or faxed number provided so the payment can be processed and credited.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    University of Minnesota Libraries

    CREDIT CARD PAYMENT FORM

    Please fill out the following form and return to the address below. Payments will be credited upon
    authorization from credit card issuer. All information must be accurate and complete.

    Name (Last, First, M.I.)

    Student ID No. Daytime Phone No.

    Credit Card No. Expiration Date

    Credit Card Type: American Express Discover Mastercard Visa

    Please charge my credit card for the amount of: $ ___________

    Signature Today’s Date

    Please return this form to: Borrowing Privileges & Fines


    110 Wilson Library
    th
    309 19 Avenue South
    Minneapolis, MN 55455
    FAX: 612.626.868

    Please refer questions to: 612.624.3383


    fines@umn.edu

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