top    Credit Card Service
Student Tuition Renewal/Order Form
Use this form ONLY if you do not wish to enter the information yourself for an automatic charge. Please fill in the form and press SEND at the bottom of the page to email it to the Trading Tutor. If you would rather fax the information, press the PRINT icon on your browser and fax the completed form to us at (256)880-2277 (be sure to use fine mode to make sure we can read it all clearly). You may direct that we use this information again in the future. 

Tuition Renewal:    $	
	  Other:    $
If “other” please specify:
Choose one:
   Visa      Mcard      discvr      amex 
Card Number:	 Exp. Date:   (mm/yy)
Name on card:	
Billing Addr:	
City:		
State/Province:		Zip/Post Code:	
Country (if outside U.S.)  

Email addr:	(must have)
Voice Phone:	

If the card is issued by a non-US bank:
Bank Name:	
Country:	


If shipping address if different from above:
Shipping Addr:	
City:			
State/Province:		Zip/Post Code:	
Country (if outside U.S.)  




Signature ____________________________________  Date ______________
Print and fax the completed form to (256)880-2277 or press the send form button below to send it via email (of course, if you Email it, a signature is not required)

  

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