CREDIT CARD
PAYMENT INFORMATION

*** Please PRINT this page and fill out all of the information in the spaces provided ***

Name:
Course Name: 
Starting Date: 
Ending Date: 
Tuition Fees CDN $:
Type of Credit Card:                   Visa       MasterCard        Amex
Name of Cardholder:
Credit Card #:  
Expiry Date:
Cardholder will pay the total amount shown to card issuer according to cardholder agreement.
Signature: 

Date: 

Once all of the information is filled out, fax it to:

Language School of Canada
Attn: Registration Department
Fax #: int+416-964-0226

Or mail to:

Language School of Canada
10 St. Mary Street
Suite 601
Toronto, Ontario M4Y 1P9
Canada