Credit Card Authorization

Student Name

Card Holder Name

Billing Address

City

State

Zip Code

Phone Number

Date of Birthday

Email

Start Date

Credit Card Type
VisaMastercardDiscoverAmerican Express

Credit Card Number

Expiration Date

CSV #

Course
—Please choose an option—EKG - Registration: $150.00 - Total: $490PHL - Registration: $150.00 - Total: $490Solar Panel - Registration: $500.00 - Total: $1450BHT - Registration: $150.00 - Total: $490HHA - Registration: $150.00 Total: $525Tax Preparation: Registration: $150.00 - Total: $695

Being the cardholder or Corporate Officer, by signing below I understand and agree to the terms set forth in this agreement, agree to pay and specifically authorize Florida International Training Institute to charge my credit card or debit card.
I further agree that in the event my card becomes invalid, I will provide FITI with a new card upon request, to be charged for the payment of any outstanding balances owed to Florida International Training Institute.

• Refund Policy 1: Program cancellation may be made in person, by electronic mail, or certified mail.

• Refund Policy 2: Refund request for any program registration with 75hr or more must be at least three days before the starting class date. Please take in consideration there is a withheld for the registration & application fee.
  I authorize Florida International Training Institute to extract the total amount of the Program from this card unless, I notify the school at least 24hrs prior to payment date.

• Refund Policy 3: Payments made for online classes will not be refunde clafter start date.

Your Initials:

Your signature: