UB ePay

1. Personal Information
(Please complete the following information)

Student First Name:	* M.I.:

Student Last Name:	* Suffix (Jr, etc.):

Student Person Number:	*

Student Sex:	*

Student Birthdate:
(use 4-digit year)	* Month: Day: Year:

Phone Number:	*

Your E-Mail:	* (for e-mail receipt)

Apply to Semester:	*


* - Required

(Please verify that this is the correct payment item.)

Orthodontics-CERT ($50.00)

This payment is the application fee for the UB School of Dental Medicine - Orthodontics -Certificate program. The fee is non-refundable.

Credit Cards / eChecks Accepted

UB currently accepts eChecks, Visa, MasterCard, AmericanExpress and Discover.

Debit Cards with Visa or MasterCard logos are accepted.

Daily limits on these cards vary, please contact your bank.

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