Credit Card Authorization

International Language Schools of Canada
Vancouver ~ Toronto ~ Montreal
Website: www.ilsc.ca e-mail: [email protected]
Credit Card Authorization Form
Student Name: ________________________________________________
I, ____________________________________, hereby authorize
Name
International Language Schools of Canada to charge the following fees
to my credit card:
 Visa
 Mastercard
 Amex
Amount:
 CAD
 CAD
 CAD
or
or
 USD
 USD
$ _______________________________________
Card Number:
__________________________________
(16 numbers)
Expiration Date:
_____ / _____
Month
Security Code:
Year
________________________________
(3 digits on back of card)
_________________________________________
____________________
Card Holder’s Signature
Date
*Please note the credit card options for ILSC - by City
If you wish to pay with a credit card or currency that is not available in the location the student is
registered, please contact the school.
Vancouver
Toronto
Montreal
Visa & Mastercard
Visa & Mastercard
Amex
Visa, Mastercard
Amex
Canadian and American Dollars
Canadian and American Dollars
Amex in Canadian Dollars only
Canadian and American Dollars
Canadian Dollars only
**Please fax or email this form to ILSC after completion Montreal 1(514) 876-4053
***Although ILSC Montreal does not charge additional fees for international
transactions your bank or credit card company MAY charge an additional fee.