Credit Card Approval Form

Credit Card Information

When applying for credit card approval, this form must be completed in full and submitted by the cardholder. Once this form has been completed and submitted by the cardholder, it becomes an authorization to charge the cardholder for the following services:

* Denotes Required Field

To the Attention of:

Your Contact in our office:

Full Name of Student:*

Program Start Date:*

Name of Cardholder:

As shown on card*

Credit Card Billing Address:*

City:*

State/Province:*

Postal Code:*

Country:*

Home Phone Number:*

Work/Cell Phone Number:*

Fax Number:

Card Holder's E-mail:*

Card Type:*

Card Number:*

PIN:

3 digit # on back of card (Discover, MC or Visa) 4 digit # on front of card (Amex)*

Expiration Date:*

Full amount to be charged on card:

in USD, which may not exceed $5000. If payment is more than $5000, please use multiple cards or contact our offices.*

Description of Serices:

i.e. deposit, final payment, extra nights, insurance, etc...

Reservation Number or Invoice Number:*

Please note: Once this form has been completed and submitted, a copy of the transaction will be e-mailed to the cardholder or faxed upon request. Charges to your credit card will be shown on your credit card statement under:
Alderly Group Marketing Inc.

By submitting this form, I am giving my authorization for the above amount to be debited from my credit card.

If you prefer to download, print, complete, & fax the Credit Card Approval Form, then click here to download the Official Form

Credit Card Approval Form

When applying for credit card approval, this form must be completed in full and submitted by the cardholder. Once this form has been completed and submitted by the cardholder, it becomes an authorization to charge the cardholder for the following services:

TEENAGER SUMMER PROGRAMS ABROAD

Testimonials

Live & Learn

Programs for 18+

Family Study Abroad

Customized Groups