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Authorization Form For Applications

This document is a credit card payment authorization form for the IELTS test administered by the IELTS UBC Vancouver Test Centre. It requests the card holder's name, credit card information including number, expiration date and CVD, as well as the test date, type of test, candidate name and address. The test fee is $295 CAD and upon completion of the form, the University of British Columbia will be authorized to charge this amount to the provided credit card.

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laleye_olumide
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59 views

Authorization Form For Applications

This document is a credit card payment authorization form for the IELTS test administered by the IELTS UBC Vancouver Test Centre. It requests the card holder's name, credit card information including number, expiration date and CVD, as well as the test date, type of test, candidate name and address. The test fee is $295 CAD and upon completion of the form, the University of British Columbia will be authorized to charge this amount to the provided credit card.

Uploaded by

laleye_olumide
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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IELTS UBC Vancouver Test Centre

Official IELTS Test Centre


Fax: 604-822-1477
Email: [email protected]
Web: www.ielts.ubc.ca

Credit Card Payment Authorization Form


IELTS Test Application
Test Fee
Price
$295

IELTS Test Fee


Includes tax

Quantity
Total

Total
$
$

For payment by Visa or Mastercard, please complete the following information, then fax the form to
+1-604-822-1477. NOTE: PLEASE DO NOT EMAIL THIS FORM. If sent via email, it will not be processed.
Card Holders Name: _____________________________ ___________________________________
(First name)

(Last name)

Credit Card: Master Card Visa


Credit Card Number: ___________________________________________________________________
Expiry Date: _________________

CVD (3 digits on back of credit card): _______________

I authorize the University of British Columbia to charge $___________________ CAD to my credit card.
Signature of Card Holder: __________________________________ Date: ________________________

Academic General Training

Test date: _________________


(DD/MM/YYYY)

Candidate Name: ________________________________ _____________________________________


(First name)

Address: ______________

__________________________

(Unit #)

_________________________
(City)

(Last name)

(Street)

________________________
(Zip/Postal Code)

Email: ____________________________

For Office Use Only:


Receipt No: __________________ Date: ______________ SRS #: ______________ Processed by: _____________

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