Class Payment – Phlebotomy Institute of PA

Class Payment Form

Name *

First

Middle

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

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Zip Code

Class cost is $1350.00 Enter your credit card information below.

Student Name *

Name on Credit Card *

Secure Payment *

This page is insecure. Credit Card field should be used for testing purposes only.

Card Number

Expiration

/

Security Code

Class Payment Fee

Price: $ 1,350.00

Total

$ 0.00