The Ogburn School, Inc



[pic]

The Ogburn School, Inc.

Payment form

We accept American Express, MasterCard, Visa, and Discover credit and debit cards.

Credit card payments: If the credit card is not in the name of the student or someone in the student’s family, you must also include a copy a copy of an identification card of the cardholder.

Check one: _____ Am Exp _____ Master Card _____ Visa _____ Discover

Amount: _____________________

Credit Card Number: ________________________________________________________________________

Security Code: _ __________________________ (This is the last three digits of the number on the back of card)

Name as appears on card:________________________________________________

Exp. Date: _________________________ Billing Zip Code

Signature: __________________________________________________

Date:______________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download