CREDIT CARD AUTHORIZATION FORM I authorize TALK International to charge below credit card for the following: o Test fee: $ 240- Davie for the test on o Test fee: $ 255- Miami Beach for the test on o Test fee: $ 455- Santo Domingo for the test on o Additional TRF/TRFs: $ 30 per certificate x = o DHL/Fedex Shipping: $ 70 ___________________ o Transfer/Refund fee $ 60 ___________________ Name: Address: Phone #: email: TALK International – IELTS TEST CENTER 3501 S. University Drive Davie, FL 33328 USA Telephone: 954 533 4546 Email: ielts@talk.edu www.talk.edu

CREDIT CARD AUTHORIZATION

I hereby authorize TALK INTERNATIONAL to charge US $ to my credit card. o Visa o MasterCard o American Express o Diners Club o Discover Credit Card Number: Expiration Date: In the name of Security Code: Signature of Cardholder: