INSTITUTION MEMBERSHIP FORM (15,001+ STUDENTS)

Description: Institution Member Application Form (15,001+ students), July 1 to June 30
Total Amount: $2000

Contact First / Last Name: /
Title:
Job Title:
Institution:
Address:
City, State, Zip: , ,
Fax Number:
Phone Number:
Email Address:
* IRS ID# 30-0150324

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you will be directed to their site for credit card processing.

The Authorize.Net Payment Gateway is a secure Internet bridge between clients and electronic check payment processing networks. They provide clients with fast, reliable and secure passage for transaction data via a 128-bit Secure Sockets Layer (SSL) Internet Protocol (IP) connection, and manage the complex routing of payment information to the appropriate credit card processors.