credit card authorization form - ielts...

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