Payment to Queenwood For Japan Tour 2017 Please find enclosed a Deposit payment for the Japan Tour 2017: Payment Option: CHEQUE / CREDIT CARD (please circle one) For credit card please complete below: Type of Card: Visa/ Amex/ Mastercard
(please circle one)
Deposit Amount : $ 500.00
Card Number: _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Expiry Date: _ _ / _ _ Cardholder Name: ……………………………………………………………………………… Student’s Name: ………………………………………… Student’s Year: …………………….
Parent’s Signature:……………………………………… Date: …………………………….