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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