Credit Card Payment Form [Nearby Lodging]
Cardholder
Company
Billing Address:
City
State
Zip code
Fax#
E-mail
Phone #
Credit card
#
Exp Date

CVC# last 3or 4 digits on back of Credit Card

Cardholder signature _____________________________

Courses attending

1st student Name
Last
2008
2nd student Name
Last
2008
3rd student Name
Last
2008
To complete your registration, please print and fax this form to; 713-472-4064 or 713-472-4041.
NATEC will fax CC receipt with authorization. Card holder must sign copy of CC receipt with authorization and fax back to NATEC

9802 Lawndale Houston TX 77017 *Office 713-472-4022 *Fax 713-472-4064 *800-446-2832