Credit Card Authorization Form

Credit Card Authorization Fall 2009

I authorize Guilford College to make the following charge to my credit card as payment of tuition.

Student________________________________________   ID_____________________________

Amount of charge $________________________     Card Type__________________________

Account No. ________________________________________     Expiration________________

Three-digit security code_____________  Name of cardholder_________________________

Billing address for credit card: ____________________________________________________

City:__________________________________ State:_________  Zip Code__________________

 

Signature_____________________  Date__________ Daytime Telephone_________________