Payment Form

Secure Payment Form

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Student Type

New Student/Applicant
(Undergraduate, Graduate, Ground, Online, or High School Cyber Summer Student)

Returning Student
(Undergraduate, Graduate, Ground, or Online)

Not a Utica University Student

Type of Payment

Payment Type

Program

[Select] Doctor of Physical Therapy MS in Occupational Therapy MS Education Programs MS in Liberal Studies MBA in Professional Accountancy

Student's Information

Student's First Name

Student's Middle Name

Student's Last Name

Student's ID Number

(9-digit number)

Contact Information

Phone Number

E-mail Address

Payment Information

Amount

$

Use same name as above

First Name on Credit Card

Last Name on Credit Card

Billing Address

Please make sure your address is typed exactly as it appears on your credit card statement

Street Address

City

State

-- Select -- Alabama Alaska Alberta American Samoa Arizona Arkansas Australian Capitol Territory British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Foreign State Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Military - Americas Military - Europe Military - Pacific Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New South Wales New York Newfoundland Newfoundland and Labrador Norfolk Island North Carolina North Dakota Northern Mariana Islands Northern Territory Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Provence of Quebec Puerto Rico Quebec Queensland Rhode Island Saskatchewan South Australia South Carolina South Dakota Tasmania Tennessee Texas Utah Vermont Victoria Virgin Islands Virginia Washington West Virginia Western Australia Wisconsin Wyoming Yukon Territory

Zip Code

Country

Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Congo-Brazzaville) Congo, Democratic Republic of Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Rep Korea, Republic of Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republ Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia,Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia, Republic of Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent & the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia S. Sandwich Isl South Sudan Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying I Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Yugoslavia Zambia Zimbabwe

Credit Card Information

Credit Card Number

Expiration

01 - January 02 - February 03 - March 04 - April 05 - May 06 - June 07 - July 08 - August 09 - September 10 - October 11 - November 12 - December 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039

CVV2 / CVC2

3 or 4 digit code on back of card

How to find your CVV2

The CVV2 is a 3- or 4-digit value printed on the card or signature strip, but not encoded on the magnetic stripe.

• MasterCard, Visa and Discover credit and debit cards have a 3-digit code. It is not embossed like the card number, and is always the final group of numbers printed on the back signature panel of the card. New North American MasterCard and Visa cards feature the number in a separate panel to the right of the signature strip.
  
  
• American Express cards have a 4-digit code printed on the front side of the card above the number. It is printed flat, not embossed like the card number.

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My card has no CVV2 imprint

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