Credit Card Authorization Form						Central Connecticut State University
	Fax to 860.832.2173 and call 860.832.2010 to verify receipt						Bursar's, P O Box 4010
	To avoid Late Fee, payments must be received by the due date						New Britain, CT  06050-4010
	Payment Options:
	1) On web, by credit card or e-check, CentralPipeline at http:pipeline.ccsu.edu
	2) By mail, check or money order, payable to CCSU, with Student ID # noted
	3) By mail or fax (860.832.2173), with credit card authorization below
	4) Payment by phone is not an option
	Student Name:				Student ID Number:
	Name on card:				Cardholder's signature:					Date:
	Credit card number:				Expiration:
						o Pmt in Full       o Payment Plan	oMC  oVisa  oDiscover
	Cardholder's daytime phone number:				Amount Paid:
						Payment includes optional Blue Chip amount of $_______
	Those whose financial obligations are overdue may be liable for both the amount due and costs of collection
	Please complete and FAX to 860.832.2173.
	Call Bursar's Office at 860.832.2010 to verify the receipt of form.