Maktab Evening

1

Parent/Student Information

2

Payment

Customer ID *

Order ID *

First

Last

Email Address

Father’s Name

Mother’s Name

Phone Number

Address for Donation Receipt

Address

Address Line 2

City

Province

Postal Code

Student 1:

 

Student 1 – Name

Student 1 – Date of Birth

Student 1 – Gender

–Select Option– Male Female

Student 2:

 

Student 2 – Name

Student 2 – Date of Birth

Student 2 – Gender

–Select Option– Male Female

Student 3:

 

Student 3 – Name

Student 3 – Date of Birth

Student 3 – Gender

–Select Option– Male Female

Student 4:

 

Student 4 – Name

Student 4 – Date of Birth

Student 4 – Gender

–Select Option– Male Female

Student 5:

 

Student 5 – Name

Student 5 – Date of Birth

Student 5 – Gender

–Select Option– Male Female

Credit Card Expiry Date

Notes

File Upload

Select Payment Method

• 
• 

Direct bank transfer

Payment Updated

Evening Qur’an & Islamic Studies *

–Select Plan– Evening Qur'an & Islamic Studies + Registration Fee Evening Qur'an & Islamic Studies Evening Qur'an & Islamic Studies – One time Fee

Amount

$50 for the first month then $0/month, for 160 installments

$0 for each month, for 160 installments

One time payment of $0

Payment Item: $10

Custom Payment Amount

$

Payment Summary

Custom Payment Amount

$

Dynamic Payment Item: $0

Submit Please Wait…

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