Mohawk College

INTERNATIONAL EDUCATION DEPARMENT
CREDIT CARD AUTHORIZATION FORM
Please complete and return this form by fax to 905-575-2362 or
mail to 135 Fennell Avenue, P.O. Box 2034, Hamilton, Ontario, Canada, L8N 3T2
(Attention: International Education Department, Room J107c)
Candidate Name: ____________________________________________________________
(Family Name) (First Name)
1. TRF FEES: For each TRF requested after application, a $25 administrative charge applies. Postage by regular mail is included in this rate.
|Total Number of TRFs Requested |TRF Fee (price per TRF) |Total |
| |$25.00 | |
2. COURIER FEES: If you would like to send your results quickly for an additional charge per copy,
please indicate on your application what destinations you would like to have couriered
|Destination |Cost (per TRF) |Number of TRFs |Total |
|Provincial (Inside Ontario) |$20.00 | | |
|National (within Canada) |$30.00 | | |
|United States of America |$45.00 | | |
|International (Overseas) |$75.00 | | |
Total Amount: _________________ + ___________________ = _________________ CDN $
1. TRF FEES 2. COURIER
CARD HOLDER AUTHORIZATION
Visa Master Card
Name: _________________________________, ___________________________________
Last Name First Name
Address: ______________________________________________________________________
Phone: ________________________________ Email: ______________________________________
Credit Card Number: ____________ - ____________ - ____________ - ____________
Expiry Date: ___ ___ / 20 ___ ___ Security Code: ______________ (last 3 digits on back of card)
Month Year
I hereby authorize MOHAWK COLLEGE to charge $ _____________ to my credit card.
Cardholder’s Signature: ________________________________ Date: ________________________
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Application for the Issue of Additional TRFs
1 Family Name:
2 Dr Mr Mrs Miss Ms (circle as appropriate)
3 Other name/s:
(These names must be the same as the names on your national identity document / passport.)
4 Address for correspondence:
5 Tel. No: Mobile No:
6 email:
7 Date of Birth: / / (day / month / year) Sex: F / M (circle as appropriate)
8 ID Type: Passport / National ID Card (circle as appropriate)
ID Document Number: (This document must be shown before a TRF can be issued.)
9 Most recent test details:
Centre Number: Candidate Number:
Date: / / (day / month / year)
| |
Centre Name:
10 Please give details below of where you would like your results sent to:
a Name of Person / Department:
Name of College / University / Organisation:
Address:
b Name of Person / Department:
Name of College / University / Institution:
Address:
I certify that the information on this form is complete and accurate to the best of my knowledge and authorise the IELTS Test Partners to forward a copy of my TRF to the department/s or institution/s listed above.
Signature: Date: / / (day / month / year)
................
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