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Century School of Languages 1485 Saratoga Ave,Suite 100 San Jose,CA 95129 Te l : (408)249-4680 Fax : (408)984-2341 www.centurylanguage.com |
| Please print out this form and mail it to Century School of Languages with the above address information and/or fax it to:int + (408)984-2341 |
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| Payment For: | |
| Name of Student(s) | |
| Selected Corse: | |
| intensive | |
| Tuition:US$ | |
| Homestay:US$ | |
| Airport Pickup:US$ | |
| TOTAL:US$ | |
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| Please charge the above amount to my credit card. | |
| Type of Credit Card: |
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| Name of Cardholder: | |
| Credit Card#: | |
| Expiry Date (mm/yy): | |
| *Cardholder will pay total amount shown to card issuer according to cardholder agreement. | |
| Signature: | |
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| Your Contact Information | |
| Century should send confirmation of payment by post,fax,or email to: | |
| Address: | |
| FAX: | |
| Email: | |