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Snack Shop Student Account Form

The Wednesday afternoon snack shop is offering an optional prepay system for students wishing to buy snacks using this form.

The system works as follows:

Pre-pay cards can be purchased for $10 or $20
When a card is purchased, the student’s name and date is entered, and the card is stored in a “card box” at the Temple.
Each time your child purchases a snack it is recorded on their card.
When the balance falls below $2, the parent will be notified and will have the option to purchase a new card (which can be done online, through the mail or in person).
For parents with multiple children: a single card may be purchased for the family.

The Snack Shop will gladly continue to accept cash, as it always has.

* Parent/Purchaser Name

Please indicate which card denominations you would like to purchase. You may purchase one card to be used for all students listed above, or separate cards for each student.

$10 Cards

$20 Cards

* Student Name(s) and attendance days

Please list the full names of all students using this account and how much you would like them to have. ex. Rob Ross, $10, and Bob Ross, $50

* Parent Email (to be contacted when the card is below $2)

* Parent Phone Number

THANK YOU! TODAH RABAH!

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the payment amount by 3% to cover credit card fees (No fee for Checking)

Total: