Invoice Number 1424
Regina Carmon
1462 Hazelwood Ter
Plainfield, New Jersey 07060
regina.carmon@tiaa.org
(732) 925-3153
Sr. Director, Relationship Manager
TIAA
Badge Name: Regina Carmon
Total Payment Due: $0.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1425
Nicole Ross
PO Box 181
Salem, New Jersey 08079
nicole@formanscholars.org
(267) 748-7916
Administrative /Accountant Assistant
Forman Action Foundation
Badge Name: Nicole Ross
Total Payment Due: $600.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1426
Jasmin McMillon
PO Box 181
Salem, New Jersey 08079
jasmin@formanscholars.org
(609) 694-2064
Scholarship Coordinator
Forman S. Acton Educational Foundation
Badge Name: Jasmin McMillon
Total Payment Due: $600.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1427
Deborah Smith
401 Lowell St
Reading, Massachusetts 01867
deborahsmith@jhancock.com
(617) 653-7972
Director
John Hancock
Badge Name: Deb Smith
Total Payment Due: $0.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1429
Tony Durkan
75 Marginal St
Marshfield, Massachusetts 02050
anthony.durkan@fmr.com
(774) 217-9693
Head of 529 Managing Directors
Fidelity Investments
Badge Name: Tony
Total Payment Due: $1,200.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1431
john hupalo
201 Washington St
Suite 2600
Boston, Massachusetts 02108
john@inviteeducation.com
(781) 264-1364
CEO
Invite Education
Badge Name: john
Total Payment Due: $1,200.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1432
Peter Mazareas
201 Washington St
Boston, Massachusetts 02108
peter@inviteeducation.com
(617) 512-0210
Founder
Invite Education
Badge Name: Peter
Total Payment Due: $1,080.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1433
Mary Nickeson
201 Washington St
Suite 2600
Boston, Massachusetts 02108
mary@inviteeducation.com
(617) 435-9500
SVP
Invite Education
Badge Name: Mary
Total Payment Due: $1,080.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1434
Marissa Rowe
1 North Capitol Avenue, Suite 900
Indianapolis, Indiana 46204
mrowe1@tos.in.gov
(317) 234-8500
Executive Director
Indiana Education Savings Authority
Badge Name: Marissa
Total Payment Due: $600.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1435
Jared Newman
100 Crosby Dr
Covington, Kentucky 41015
Jared.Newman@fmr.com
(513) 500-6659
Managing Director 529
Fidelity Investments
Badge Name: Jared Newman
Total Payment Due: $1,080.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1436
Cory Latham
3 Winding Rd.
3 Winding Rd.
Bedford, New Hampshire 03110
cory.latham@fmr.com
(603) 582-0167
Managing Director, 529
Fidelity Investments
Badge Name: Cory
Total Payment Due: $1,080.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1437
Lael Oldmixon
PO Box 755120
Fairbanks, Alaska 99775
lmoldmixon@alaska.edu
(907) 450-8115
Executive Director
Education Trust of Alaska
Badge Name: Lael
Total Payment Due: $1,080.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1438
Bonnie Carroll
PO Box 755120
Fairbanks, Alaska 99775
bccarroll@alaska.edu
(907) 978-8818
Director of Marketing
Education Trust of Alaska
Badge Name: Bonnie
Total Payment Due: $1,080.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1441
Kay Ceserani
80 University Ave, Westwood, MA
Westwood, Massachusetts 02090
kceserani@meketa.com
(503) 929-2879
Consultant
Meketa Investment Group
Badge Name: Kay Ceserani
Total Payment Due: $1,440.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1442
Dawn Hall
PO Box 83720
Boise, Idaho 83720
dhall@idsaves.idaho.gov
(208) 484-4906
Executive Director
IDeal Idaho College Savings Program
Badge Name: Dawn Hall
Total Payment Due: $600.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1443
Goldie Bishop
PO Box 83720
Boise, Idaho 83720
gbishop@idsaves.idaho.gov
(208) 332-2936
Project Manager
IDeal Idaho College Savings Program
Badge Name: Goldie Bishop
Total Payment Due: $540.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830
Invoice Number 1444
Edward Kaminski
30 Hudson St
22nd Floor
Jersey City, New Jersey 07302
edward_kaminski@nylim.com
(908) 347-1882
Corporate Vice President
New York Life Stable Value
Badge Name: Ed Kaminski
Total Payment Due: $0.00
Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
| Credit Card Information |
|
Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX □ Other |
| Cardholder Name (as shown on card): |
| Card Number: |
| Expiration Date (mm/yy): |
| Cardholder ZIP Code (from credit card billing address): |
I, , authorize to charge my credit card above for agreed upon purchases.
I understand that my information will be saved to file for future transactions on my account.
Customer Signature Date
College Savings Foundation
1300 Piccard Drive, LL 14 Rockville, MD 20830