Discover/MasterCard/Visa
Authorization Form
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Student's Name: ___________________________ Student's ID#: ______________ Please Print |
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Card Holder I authorize the use of my MasterCard/Visa #________________________________ at CCM for the ____________ semester. ____________________________ Card Holder's Signature Date |
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Student I authorize any refund due me, that was originally paid with a MasterCard/Visa, to be issued as a credit to the card holder's account: ________________________________ Student's Signature Date |
This form is required:
If the student is using someone else's credit card to pay their debt.
When someone other than the student pays the student's debt with a charge card.