Levan Center Payment Form

Note: All fields marked with an * are required. All other fields are optional.

User Information

First Name:

Last Name:

Company Name:

Email Address:

Phone number:

Address:

Apt/Suite/Etc.:

City:

State:

Zip code:

Country:

This is my billing address

Payment Reason:

Amount:

Invoice #:

Comments:

Acknowledgement Statement:
I hereby authorize the Alan B. Levan | NSU Broward Center of Innovation to charge my credit card for payment of goods and/or services purchased.

Refund Policy Agreement: *

To request a refund, please contact us at levanfinance@nova.edu or 954-262-8324 with your order details.
Once a refund is approved, the refund will be processed to the original payment method within 3 to 10 business days.

By checking this box you are agreeing to the above Refund Policy Agreement.