Student Payment Confirmation

STUDENT INFORMATION

Student ID *

Student Name *

Instrument Major *
—Please choose an option—PianoViolinGuitarVoiceFlute

Current Grade *
—Please choose an option—Pre ElementaryElementaryIIIIIIIVVVIPra PKPK 1PK 2PK 3PKg 4

Name or Initial of Major Teacher *

TRANSFER INFORMATION

Transferor Name *

Transferor email *

Transfer Date *

Transfer Amount (IDR) *

Originating Bank *

Originating Bank Account Number*

Please attach your transfer receipt (.jpg|.jpeg|.pdf only with a maximum size of 2Mb) *

Optional message

Fields marked * are required

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