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CREDIT CARD AUTHORIZATION FORM - IELTS · PDF fileIELTS is jointly owned by the British Council. IDP: IELTS Australia and University of Cambridge ESOL Examinations. CREDIT CARD AUTHORIZATION

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  • IELTS is jointly owned by the British Council. IDP: IELTS Australia and University of Cambridge ESOL Examinations.

    CREDIT CARD AUTHORIZATION FORM

    1. TRF FEES: For each TRF requested after application, a $25 administrative charge applies.Postage by regular mail is included in this rate.

    2. COURIER FEES:

    Total Amounts: + = CDN $

    If you would like to send your results quickly for an additional charge per copy,please indicate on your application what destination you would like to have couriered.

    Candidate Name: (Family Name) (First Name)

    Please complete and return or mail this form to Suite 3006-2300 Yonge St. Toronto, Ontario, Canada, M4P 1E4 (Attention: IELTS Registration)

    Total Number of TRFs Requested TRF Fee (price per TRF) Total

    $25.00

    Destination

    1. TRF FEES 2. COURIER

    CARD HOLDER AUTHORIZATION

    Visa Master Card

    Name: _________________________________, ___________________________________

    Address: ______________________________________________________________________

    Phone: ________________________________ Email: ______________________________________

    Credit Card Number: ____________ - ____________ - ____________ - ____________

    Expiry Date: ___ ___ / 20 ___ ___ Security Code: ______________ (last 3 digits on back of card)

    I hereby authorize Precise Testing Solutions to charge $ _____________ to my credit card.

    Cardholders Signature: ________________________________ Date: ________________________

    Last Name

    Month Year

    First Name

    Cost (per TRF) Number of TRFs TotalProvincial (inside Ontario)

    National (within Canada)

    United States of America

    International (Overseas)

    $20.00

    $30.00

    $45.00

    $75.00

    www.ieltscentres.com

  • 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)

    www.ieltscentres.com