You may pay for language lessons using your credit card.
We accept Visa, Master Card, Amex, Discover.
Bring your credit card to our office when you enroll for language lessons.
You may also print this page, fill it in and bring it to us or mail it. (Additional forms in office).
If you prefer, you may phone us with your credit card information. (860) 202-9011
If you prefer, you may pay us by check, payable to Second Language, LLC.
Amount to be charged: $_______
First name as it appears on card: ______________
Last name as it appears on card: ______________
Card Type: ______________ (Visa, Master Card, Amex, Discover)
Card Number: ____________________________
Expiration date: Month: _______ Year: _______
Card Security Code: _______ (3 or 4 digit number on back of card)
Address line 1: ____________________________
Address line 2: ____________________________
City: ___________________________________
State: _______
Zip code: ______________
Email (optional): ____________________________
Telephone: ____________________________
Signature: ____________________________