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INTERNATIONAL FIELD STUDIES CREDIT CARD AUTHORIZATION FORM
I, ______________________________, HEREBY AUTHORIZE INTERNATIONAL FIELD STUDIES TO DEBIT MY CREDIT CARD WHICH IS REQUIRED AS A DEPOSIT, OR FOR ANY AND ALL PAYMENTS OF THE PROGRAM FEES.
*CREDIT CARD COMPANY (VISA, MASTERCARD, AM. EXPRESS): _______
*CARDHOLDER NAME: ________________________________________ *STREET ADDRESS: ____________________________________________ CITY, STATE, ZIP: ____________________________________________
*CREDIT CARD NUMBER: ______________________________________
*EXPIRATION DATE: ___________________________________________ *SECURITY NUMBER: ____________
*AMOUNT TO CHARGE: $________________________
*SIGNATURE: __________________________________________________
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