credit card authorization form - ielts...
TRANSCRIPT
IELTS is jointly owned by the British Council. IDP: IELTS Australia and University of Cambridge ESOL Examinations.
CREDIT CARD AUTHORIZATION FORM
1. TRF FEES: For each TRF requested after application, a $25 administrative charge applies.Postage by regular mail is included in this rate.
2. COURIER FEES:
Total Amounts: + = CDN $
If you would like to send your results quickly for an additional charge per copy,please indicate on your application what destination you would like to have couriered.
Candidate Name: (Family Name) (First Name)
Please complete and return or mail this form to Suite 3006-2300 Yonge St. Toronto, Ontario, Canada, M4P 1E4 (Attention: IELTS Registration)
Total Number of TRFs Requested TRF Fee (price per TRF) Total
$25.00
Destination
1. TRF FEES 2. COURIER
CARD HOLDER AUTHORIZATION
Visa Master Card
Name: _________________________________, ___________________________________
Address: ______________________________________________________________________
Phone: ________________________________ Email: ______________________________________
Credit Card Number: ____________ - ____________ - ____________ - ____________
Expiry Date: ___ ___ / 20 ___ ___ Security Code: ______________ (last 3 digits on back of card)
I hereby authorize Precise Testing Solutions to charge $ _____________ to my credit card.
Cardholder’s Signature: ________________________________ Date: ________________________
Last Name
Month Year
First Name
Cost (per TRF) Number of TRFs TotalProvincial (inside Ontario)
National (within Canada)
United States of America
International (Overseas)
$20.00
$30.00
$45.00
$75.00
www.ieltscentres.com
Application for the Issue of Additional TRFs
1 Family Name:
2 Dr Mr Mrs Miss Ms (circle as appropriate)
3 Other name/s:
(These names must be the same as the names on your national identity document / passport.)
4 Address for correspondence:
5 Tel. No: Mobile No:
6 email:
7 Date of Birth: / / (day / month / year) Sex: F / M (circle as appropriate)
8 ID Type: Passport / National ID Card (circle as appropriate)
ID Document Number: (This document must be shown before a TRF can be issued.)
9 Most recent test details:
Centre Number: Candidate Number:
Date: / / (day / month / year)
Centre Name:
10 Please give details below of where you would like your results sent to:
a Name of Person / Department:
Name of College / University / Organisation:
Address:
b Name of Person / Department:
Name of College / University / Institution:
Address:
I certify that the information on this form is complete and accurate to the best of my knowledge and authorise the IELTS Test Partners to forward a copy of my TRF to the department/s or institution/s listed above.
Signature: Date: / / (day / month / year)
www.ieltscentres.com