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This document is a credit card authorization form for an international student to pay fees to Conestoga College. It requests the student's name, program of study, credit card details including card number, expiration date, security code and cardholder's name. By signing, the student agrees for Conestoga to charge the specified amount to their credit card for tuition or other fees, but future charges would require a new authorization.
This document is a credit card authorization form for an international student to pay fees to Conestoga College. It requests the student's name, program of study, credit card details including card number, expiration date, security code and cardholder's name. By signing, the student agrees for Conestoga to charge the specified amount to their credit card for tuition or other fees, but future charges would require a new authorization.
This document is a credit card authorization form for an international student to pay fees to Conestoga College. It requests the student's name, program of study, credit card details including card number, expiration date, security code and cardholder's name. By signing, the student agrees for Conestoga to charge the specified amount to their credit card for tuition or other fees, but future charges would require a new authorization.
C re dit C a rd Au tho ri zati on For m SCANNED COPIES OF THIS FORM WILL NOT BE ACCEPTED
Please fax completed form to the International Office at 519-748-3520
Applicant Information PLEASE PRINT CLEARLY
Student Name: Student Number: Email Address: Program Selection: Payment Information
Visa Card Number: Master Card Amex
Card Holder Name: Amount to be charged: Signature: Expiry Date (MM/YYYY): Security Code:
Note: By signing this waiver, you agree that Conestoga is not responsible for any charges other than the transaction specified on this form. Future transactions will require the submission of another authorized form.