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Account Information

Please provide the information requested below.

Rivier Student ID (Ex. A1234567890)*
Student First Name*
Student Last Name*
Payer's Full Name*
Payer's Daytime Phone Number*
Payer's Mailing Address
Payer's Mailing Address - Line 2
City
State
Zip

Payment Section
Pay TowardPay Amount
Student Account   $

   

Total: $  0.00


Payment Method & Account Information

Please provide your payment type and payment account information.

Effective Payment Date 3/4/2015
E-mail Address*


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