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Credit Card Payment Form
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Please complete this form
when paying the CLEP examination fee and/or the testing center service fee
with a MasterCard or VISA. Return the completed form with the CLEP registration
form.
Print clearly or type the information in the space below.
Payment Information:
Breakdown
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__ Please charge my VISA a total of | $____________ | |||
$77.00
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$25.00
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__ Please charge my MasterCard a total of | $____________ |
CLEP
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WPU
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Credit Card Number (plus 3 digit code: back of card) | Expiration Date: | |
___ ___ ___ ___ /___ ___ ___ ___ /___ ___ ___ ___ /___ ___ ___ ___ /___ ___ __ |
_______
/_______
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month/year
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__________________________________________________ | ___________________ |
Signature of Cardholder | Date |
Examinee Information:
_______________________________________ | __ __ __ - __ __ - __ __ __ __ |
Name of Examinee | Social Security Number |
_________________________________________________________________________ | _________________ |
Address City State Zip | Telephone |
If you have any questions,
please contact the Office of Testing, William Paterson University at 973-720-2570.
Office of Testing | Telephone: 973-720-2570 |
William Paterson University | Fax: 973-720-2588 |
300 Pompton Road, Wayne, NJ 07470 | email: officeoftesting@wpuj.edu |