Please complete this form and mail or fax it to ELC along
with the application form.
Student Name:
_________________________________________________________________________________
|
| . |
Last |
First |
Middle |
|
| Application
fee: |
$________ |
|
|
|
| Tuition
fee: |
$________ |
|
|
|
| Lodging
fee: |
$________ |
(A $150
deposit is required no less than 2 weeks before arrival.
The $150 deposit is not necessary if lodging fee is paid
in full.) |
| Airport
Transfer: |
$________ |
|
|
|
| Express
Mail: |
$________ |
(Express
Mail Service costs $50 and is usually optional. Express
mail is required if an I-20 mail is requested less than
2 weeks before course start date.) |
| Other
fee: |
$________ |
Description:
____________________ |
| Total: |
$________ |
|
|
|
|
| I will
pay the above fees by:
|
| 1)
VISA _____ |
MASTER
CARD _____ |
AMERICAN
EXPRESS _____ |
| |
| I authorize
the English Language Center to charge the above amount to
my credit card.
|
| Credit
Card #: ___________________________ Expiration Date: _______________
|
| Name
on Card: ___________________________ Signature: _______________
|
| 2)
International Money Order ________ or a personal check from
a U.S. bank _________
Please make checks
payable to ELC and send them to:
The English Language
Center
10850 Wilshire Boulevard, Suite 210
Los Angeles, CA 90024
Date sent:
_______________
|
3) Wire Transfer
________
Please remit
wire transfer to:
c/o ComericA Bank
Wire Transfer Department
10900 Wilshire Boulevard
Los Angeles, CA 90024
Account #1891022749
ABA 121137522
Date Transfer
was made: _______________
|
| *
Please include the student's name with your payment.
English Language
Center Refund Policy:
Refunds, excluding the non-refundable application fee,
for the first session and any continuing session for which
the student is enrolled can be made for any cancellation
received before the first day of the session. Housing
and tuition for the first session and any other session
for which the student has enrolled are non-refundable
after the first day of class of the session. All bank
fees incurred in sending and receiving payment are to
be paid by the applicant. For exceptions to this policy,
please refer to the page 2 of the application form.
|
