CREDIT CARD AUTHORIZATION - Embracing the Kingdom. Informing Academia. Supporting the Believer.

I authorize Jackson Theological Institute (JTI) to make charge(s) to my credit card in order to pay for tuition and fees as billed by the Institute for classes in which I enroll. I understand and agree that this authorization shall remain effective until terminated in writing by student and confirmed termination from JTI.

Name *

First

Last

Email *

Start Date *

Please Select a Learning Method *

Online
Hybrid

Please Check a Degree Plan *

Bachelor
Masters
Certificate
Audit

Please Select a Payment Plan *

Pay-As-You-Go
Split Payments 40% - 40% - 20%

Credit Card *

Card # *

Expiration Date *

CVV (On back of card) *

Name on Card *

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

I authorize my card to be charged the amount I selected. *

Please answer this simple captcha to help us eliminate spam *

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Or download the form in PDF format and email it back to registration@jtinstitute.org