2010 ELC Pre-payment agreement

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ELC Pre-payment Agreement Please complete this form and send to ELC along with the application form. Student Name: _________________________________________________________________________ Last First Middle Application fee: $__________ $150 application fee due upon booking Tuition fee: $__________ Lodging fee: $__________ A $150.00 deposit is required to reserve space for all ELC accommodations. See application form for details of prepayment requirements.

Airport Transfer: $__________ ELC offers a $125 one-way transfer to ELC housing or $210 round-trip Express Mail: $__________ ELC offers a $75 optional express mail service. Express mail is required if an I-20 form is requested less than 4 weeks before course start date. Materials fee: $__________ $35 materials fee due upon booking Other fee: $__________ Description:______________________________________ Total: $ *************************************************************************************************************************** I will pay the above fees by: 1) Visa _____ Master Card _____ I authorize the English Language Center to charge the above amount to my credit card.

Credit Card #: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expiration Date: __ __ / __ __ Identity Code: __ __ __ (3 digit number on the back of the card on the signature line) Name on Card: ___________________________________________ Signature: ________________________ Billing Address of Cardholder: ... more. less.

Street: _____________________________________ Apt #: ____________________________ City, State: ___________________________________ Zip/Postal Code: ___________________ Country: _____________________________________ 2) International Money Order _____ or a personal check from a U.S. bank _____ Please make checks payable to ELC and send them to: English Language Center 20 Park Plaza, Suite 1201 Boston, MA 02116 Date sent: _________________________ 3) Wire Transfer* Please remit wire transfers to: c/o Bank of America 100 West 33rd Street New York, NY 10001 USA Account Name: English Language Center Account # Boston : 0046 3052 8521 Account # Los Angeles : 0046 3052 8738 Routing #026009593 Swift Code: BOFAUS3N Date of transfer: _____________________ *When paying by wire, please be sure to include all bank costs and include the student's name with your payment. For any cancellation ELC receives by the first day of the program, most fees are fully refundable.<br><br> The exceptions are: - The application fee of $150 and the express mail fee of $75 are non-refundable. - Housing deposits are refundable only according to the conditions listed in the accommodations section of the application . - Airport Transfers are refundable with cancellation at least one business day before the service date requested.<br><br>

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