connect school of languages-study ESL

Connect School of Languages
info@connectlanguage.com
890 Yonge Street
Toronto, Ontario
M4W 3P4 Canada
Tel: 416-850-8602
Fax: 416-850-8601
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Connect Credit Card Authorization Form

Please print out this form and mail Connect or fax to: Int + (416)850-8601 CREDIT CARD PAYMENT INFORMATION
Payment For
Name of Student(s):*
Registration Fee:
Tuition:
Homestay Placement Fee:
Homestay Fee:
Pickup:
Total:*
Credit Card Information
Please charge the above amount to my	VISA MASTERCARD
Name of card holder:*

Credit Card Number:*
Expiry Date:*
Cardholder will pay total amount shown to card issuer according to cardholder agreement. Signature:
Your Contact Information Connect must send a confirmation of payment by mail, fax or email.
Mailing Address
Phone:
*Email:**