Credit Card Payment Form

Please Print

Card Holder Name:	__________________________________________
Phone :	__________________________________________
E-Mail:	__________________________________________
Address:	__________________________________________
Credit Card Number:	- - - (Max. 16 digits)
Credit Cards:
OTHER:	__________________________________________
Expiration Date (MM/YY):	___/___

Please charge the following:

I hereby authorize Tecnológico de Monterrey to charge my credit card for the educational services selected.

Please complete and fax to: +52-669-989-2050