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1. Social Security Number:
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2. Last Name: _________________________________________ 3. First Name: _________________________________________ 4. Address: _________________________________________
5. City, State and zip: _________________________________________ 7. Semester: ____________________ Today's Date: ____________________ 8. Amount Due: $____________________ 9. Type of Payment - check one: ____ Check ____ Money Order ____Credit Card
10. For Credit Card Payment only - Please fill in the boxes below: 
1. Everyone must complete items I through 9. For credit card payment, also complete item number 10. 2. All checks and money orders must be made payable to ''Lehman College'' 3. Payments can be mailed to Lehman College Bursar's Office: 250 Bedford Park Blvd. West Bronx, NY 10468-1589. when the office is closed ...OR...Credit Card Payments can be faxed to 718-960-7258. 4. REVIEW THIS FORM! Verify your information is correct and a check or money order is in the envelope. If paying by credit card, verify the card number, expiration date and cardholder's signature are correct. I understand that I am liable for the full amount of my tuition and fees, whether or not I receive grants, scholarships, or other financial support. I understand that if I do not make full payment of my tuition and fees and other college bills, and my account is sent to a collection agency, I will be responsible for all collection costs, including agency fees, attorney fees and court costs, in addition to any amounts I owe Lehman College. Furthermore, a non-payment or default judgement against my account may be reported to a credit bureau and reflected in my credit report.
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