General Payment Form

If you are a current student, please complete payments by logging in to your my.IndianaTech account.

Please complete the following information as thoroughly as possible. Required fields are denoted by an asterisk. (*)

Personal Info

Name*

First Last

Address*

Street Address Address Line 2 City ZIP Code

State

Address*

Address Line 2

City*

State / Province / Region

Zip Code

Country*

Phone*

Email*

Payment Info

First Name*

Family Name / Last Name*

Student ID

Date of Birth

mm/dd/yyyy

Payment Category*

Traditional Undergraduate Student
Evening and Weekend Student
Other

What is this payment for?*

Date of Rental*

Time of Rental*

Example 1:00 pm - 5:00 pm

Comments

Banquet Cost

Students:$25 per ticket, or $160 per table

Friends, Faculty and Staff: $55 per ticket, or $350 for a table

Amount to Be Paid*

Payment Option Information

Flywire
Flywire is the best method for making payments using foreign currency.

Wire Transfer
Select this option if you will be sending a wire transfer from your bank.

Select a Payment Option.*

Flywire (recommended)
Wire Transfer

Amount in Cents

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