From:

Name of client: Street : Post Code / City / Country

To:

Phone

Sprachcaffe International/SCI Triq Alamein Pembroke, PBK 1776, MALTA

Fax: 00356 25 70 10 05 Tel.: 00356 25 70 10 0

Language trip to:..Booking Number: . Students name:.................. Dear Sir / Madam, I hereby allow you to charge + 2% credit card fee TOTAL EUR EUR EUR USD USD USD GBP GBP GBP CAD CAD CAD

from the following Credit Card: VISA MASTER CARD AM.EXPRESS Card Holder: Card Number: Expiry Date: Control Number: Please attach: - a readable copy of the credit card (both sides) - a readable copy of the passport / ID card of the holder of credit card holder (except company credit cards) Place, date .....................................................

Signature of card holder,

...............................................................