IELTS PAYMENT BY DEBIT/CREDIT CARD - Guildford PAYMENT BY DEBIT/CREDIT CARD ... IELTS Exam : 2015 - 15 0 ☐ IELTS Exam 2016 - 155 ☐ ... IELTS Weekend Preparation Course: ...

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IELTS PAYMENT BY DEBIT/CREDIT CARD "I understand that my test fees are only refundable or transferable up to 5 weeks before my test date (minus an administration fee of 30). Less than 5 weeks before my test I am liable to lose my full test fee unless I can provide adequate medical proof to support my application to cancel or postpone." "I understand that my course fees are not transferable or refundable if my application is accepted. I note that IELTS courses are not eligible for a student visa." Signature: Date: NAME OF APPLICANT/ CANDIDATE: CARD NUMBER: EXPIRY DATE: START DATE if on card: CARD TYPE, e.g. Visa, Visa debit, MasterCard (NB: NO Amex taken) AMOUNT PAYING: Please tick IELTS Official Practice Materials 2 (with DVD): 15 IELTS Evening Preparation Course: 2015 - 169 2016 - 175 IELTS Exam: 2015 - 150 IELTS Exam 2016 - 155 IELTS One Day Workshop: 2015 - 69 2016 - 78 IELTS Weekend Preparation Course: 435 SECURITY NUMBER: FINAL 3 DIGITS ON BACK OF CARD ISSUE NUMBER: SWITCH & SOLO If no issue number, start date CARDHOLDER NAME IF DIFFERENT TO APPLICANT: CARDHOLDER ADDRESS IF DIFFERENT TO APPLICANT: CARDHOLDER TEL: DATE DETAILS TAKEN: (For office use) TAKEN BY (NAME): (For office use)

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