RESCU Payment Form

Name

First Name

Last Name

By checking this box, I consent to having this transaction processed as a Cash Advance. I acknowledge there may be additional fees associated with this transaction. Transactions are posted on the next business day, if received after 5pm, weekends or on holidays. *

Agree

I affirm that the card listed above is issued in my own name and I understand that I cannot make a payment with someone else's card. *

Agree

Today's Date *

No Future Dates

MM

DD

YYYY