Mail Payment Form

Courses4Teachers, University of Pacific
Attn: Karin Alexander
696 San Ramon Valley Blvd. #518
Danville, CA 94526

Name:
Address:
City :
Zip Code:
Home Phone Number:
Work Phone Number:
Email Address:
Birthdate:
Social Security Number:
Name of School In Which You Teach:
Name of School District (no abbreviations please):
Course Number and Title:
Number of Units You Wish to Earn (1, 2, or 3):

Payment ($93 per semester unit)
Select a Payment Type:

Personal check, payable to University of the Pacific (Note: Each course needs a separate check.)

Amount authorized to charge:
Visa or MasterCard
Card Number:
Expiration Date: