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
2nd student Name
Last
3rd student Name
Last
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
Registrations require payment to confirm class registration. Courses require minimum students registered for class to be held. Please call to confirm class schedules a week before course date.

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