PAYMENT AUTHORIZATION FORM STUDY MATERIAL Study Materials Study Materials are mailed via express courier Total Study Material express courier Fee Ontario ($20.00) Canada ($30.00) USA ($45.00) International ($75.00) Specimen Materials $50.00 Insight into IELTS $80.00 IELTS Express (Intermediate) $45.00 Top Tips for IELTS (Academic) $55.00 Top Tips for IELTS (General Training) $55.00 IELTS 8 $90.00 IELTS 9 $90.00 Express Courier Fee # Additional Material # ADDITIONAL MATERIAL FEE INFORMATION: If you are purchasing more than one book, the express courier charge for any additional books will be charged $5.00 each Total Fees TOTAL $ Complete all information below. NOTE: Declined credit card transactions will be assessed a Handling Fee of $20.00 ============================================================================== CREDIT CARD AUTHORIZATION Name: ________________________________________________________________________________ Address: ______________________________________________________________________________ Phone: __________________________________E-mail: ________________________________________ □ – VISA □ – MASTERCARD Expiry Date: _____ / _____ (Month / Year ) - - - Card Number: I authorize CONESTOGA COLLEGE to charge $ ___________ Cdn. to my credit card. Signature of Card Holder: _______________________________________ Date: ___________________ Receipt #: ______________________________________For Office Use Only – 30-June-16

Payment Authorization Form - SM - IELTS Canada · PDF filePAYMENT AUTHORIZATION FORM ... Specimen Materials : $50.00 ; Insight into IELTS : $80.00 ; ... Payment Authorization Form

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Page 1: Payment Authorization Form - SM - IELTS Canada · PDF filePAYMENT AUTHORIZATION FORM ... Specimen Materials : $50.00 ; Insight into IELTS : $80.00 ; ... Payment Authorization Form

PAYMENT AUTHORIZATION FORMSTUDY MATERIAL

Study Materials Study Materials are mailed via express courier Total Study

Material express

courier Fee Ontario ($20.00)

Canada ($30.00)

USA ($45.00)

International ($75.00)

Specimen Materials $50.00

Insight into IELTS $80.00

IELTS Express (Intermediate) $45.00

Top Tips for IELTS (Academic) $55.00

Top Tips for IELTS (General Training)

$55.00

IELTS 8 $90.00

IELTS 9 $90.00

Express Courier Fee

# Additional Material

# ADDITIONAL MATERIAL FEE INFORMATION: If you are purchasing more than one book, the express courier charge for any additional books will be charged $5.00 each

Total Fees TOTAL $

Complete all information below. NOTE: Declined credit card transactions will be assessed a Handling Fee of $20.00

==============================================================================CREDIT CARD AUTHORIZATION

Name: ________________________________________________________________________________

Address: ______________________________________________________________________________

Phone: __________________________________E-mail: ________________________________________

□ – VISA □ – MASTERCARD Expiry Date: _____ / _____ (Month / Year )

- - -Card Number:

I authorize CONESTOGA COLLEGE to charge $ ___________ Cdn. to my credit card.

Signature of Card Holder: _______________________________________ Date: ___________________

Receipt #: ______________________________________For Office Use Only – 30-June-16