CREDIT CARD
INFORMATION
ONE TIME CREDIT CARD AUTHORIZATION FORM
(Complete and Send us this information)
Student Name:______________________________________
Student Address: ____________________________________
D.O.B.: _________ Phone: ____________
School Name: _______________________________
I, ________________________________________authorize
ABC Educ. to charge on my Credit Card the following:
VISA ______ MASTER CARD _____ DISCOVER _____
CARD HOLDERNAME:_________________________________
CREDIT CARD No:____________________________________
EXPIRATION DATE: _____________________
SECURITY CODE: _______________
_________________________________________________
ZIP CODE: _____________________
PHONE: ___________________________
DRIVER LICENSE No.: __________________________________
Transcript ____ Diploma ______ Tuition____ Other ______
SIGNATURE: _________________________________________
BANK
DEPOSIT
PAYMENT with check or cash: You can pay with Bank Deposit in our bank account in Florida, Georgia, S.and N. Carolina.