Keio Academy of New York—Payment Information

If you have questions, please feel free to contact us. VISA or MASTERCARD ONLY.

Donor's Information

Description Donation
Student Name First Name: Last Name:
 ex: Taro  Keio   (If you are parents of Keio's student, please specify.)
Graduate Year
 ex: 2011   (If you are a Keio NY Alumni member.)
Current Employer  ex: Keio Academy of New York
Anonymous   Anonymous Donation
Amount * US$

 * required item

Billing Information

Name * First Name: Last Name:
E-Mail * ex:
Street Address *  ex: 3 College Road
City  *  ex: Purchase
State *  ex: NY
Postcode  *  ex: 10577
Country *  ex: USA
Phone Number *  ex: 03-1111-1111
Fax Number  ex: 03-1111-1112

 * required item