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
Date Format: MM slash DD slash YYYY

mm/dd/yyyy
Payment Category*
- Traditional Undergraduate Student
- Evening and Weekend Student
- Other
What is this payment for?*
What is this payment for?*
What is this payment for?*
What is this payment for?*
What is this payment for?*
Date of Rental*
Date Format: MM slash DD slash YYYY
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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