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:	*

DENTPIN (use 8-digit number):	*

* - Required

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

IDP Supplemental Application Fee ($100.00)

The IDP Application Fee is collected from all applicants to the School of Dental Medicine Doctor or Dental Surgery degree program. All supplemental application fees submitted, regardless if an applicant completes their application, are 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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