Please fill out this form if you would like to pay by credit card.
Name (as it appears on your credit card)
We only accept American Express (A 3% handling and processing fee will be added to each charge)
Please return this form directly to:
International Classroom
7290 Route 131
P.O. Box 263
Weathersfield, Vermont 05151
I, ___________________________________________________ authorize
International Classroom to charge my American Express card with the amount/s and on the date/s stated above.
Signed ___________________________________________ Date_________________
Town State Zip Code
You must authorize International Classroom to charge your card for each payment. Please fill
out each date and the amount you would like charged to you credit card. PLEASE NOTE: If you fill out this form with a few payments and decide later you would like to add more, you must fill out and mail us a new form giving International Classroom permission to charge a given amount on specific dates.
Amount to be charged $_____________Date_____________
Amount to be charged $_____________Date_____________
Amount to be charged $_____________Date_____________
Card Number Expiration Card ID #
Street Address (card billed to)
Amount to be charged $_____________Date_____________
Amount to be charged $_____________Date_____________
