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If you prefer, you may phone us with your credit card information. (860) 202-9011
You may pay us by check, payable to Second Language, LLC.
If you wish, you may print this page, fill it in and bring it to us or mail it.
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: _______
Address line 1: ____________________________
Address line 2: ____________________________
City: ___________________________________
State: _______
Zip code: ______________
Email (optional): ____________________________
Telephone: ____________________________
Signature: ____________________________
This authorizes Second Language, LLC to charge the amount indicated above for language lessons one time only. This information will be destroyed once the charge is authorized. |