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					Credit Card Payment Form                                                                                                     The George Washington University
                                                                                                                                      Office of the Registrar @
                                                                                                                                              Colonial Central
SUBMISSION INSTRUCTIONS:                                                                                                           Marvin Center Ground Floor
If you are submitting your request in person, please visit the Office of the Registrar @ Colonial Central, on the Ground        Phone Number: (202) 994-4900
Floor of the Marvin Center on 21st Street NW.                                                                                     Fax Number: (202) 994-0282

If you are mailing your request, please submit it to: Office of the Registrar, 44983 Knoll Square, 2nd Floor, Ashburn, VA 20147


                                         Use this form for Office of the Registrar transactions only
                                          (not for tuition payments or other university charges).




Student's Name



Cardholder's Name



Cardholder's Phone                                                                         Cardholder's Email



I authorize The George Washington University to charge (amount in U.S. dollars)                          $
to the following credit card account:


Type of Card (check one):                          MasterCard                                    VISA



Credit Card Number:                      -             -             -                      Expiration Date (MM/YYYY) :

                                                                             * The credit card verification code is a three-digit number printed on
Credit Card Verification Code *:                                               the back of your credit card.




Credit Card Billing Address:




Signature:       __________________________________                           Date:



FOR OFFICE USE ONLY
DATE RECEIVED:                                                                BY:                                                 AMOUNT:

				
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Description: Credit Card is a non-cash payment method is simple and credit services. Credit cards are generally long 85.60 mm, width 53.98 mm, 1 mm thick plastic cards (size is a series of documents by the definition of ISO 7810,7816), by a bank or credit card company in accordance with the user's credit card holders with the financial issue, holding Card credit card holders are not required to pay cash, pending further payment when the balance sheet date. In addition to some combination of credit card and debit card, the general credit and debit cards, ATM cards with different credit card will not be deducted from the funds directly to the user's account.