Drexel ELC IELTS Credit Card Form

DREXEL ELC IELTS CREDIT CARD PAYMENT FORM

Fill out this form and then print it out - you will NOT be submitting any credit card information through the internet.

If you are submitting your application on line, FAX this form to 215-895-6775.

If you are submitting by mail, send it with your IELTS Application form to:

Drexel ELC
ATTN: IELTS Administrator
229 N. 33rd Street
Philadelphia, PA. 19104 USA

DO NOT EMAIL OR SEND AS A PDF.

Date
Candidate's Name
Amount Charged to Credit Card

For: IELTS Registration Fee    Test Date:

       IELTS Test Preparation Seminar(s)
       Other

Type of Card: Visa Mastercard American Express

Cardholder's Name (as it appears on the card)

Cardholder's Signature

Account Number

Expiration Date