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Card Card Authorization (one time only) Form
Card Card Authorization (one time only) Form
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
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
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
*
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