EDUFAX - Credit Card Services




	e d u f a x *for all the facts about your education*

Help with:
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Dear Student / Parent / Applicant / Student / Educator / Consultant,

This form can be used with the most commonly used web browsers. If you are unable to use this form, please contact EDUFAX.

Payment for Services
Volunteer Contribution

PAYMENT FOR SERVICES

Please read the Description of Services and Contracts carefully to verify the services you are requesting and to ascertain the correct payment. For questions or clarifications, please contact EDUFAX before submitting payment.

Name of Student/Applicant:
Date of Birth of Student/Applicant:	[please use numbers only, in the following format: 08/07/87]

Please enter the correct payment amount:
	Educational Consultation:	$
	College Applications:	$
	College Transfer:	$
	Graduate School Applications:	$
	Therapeutic Program Placement:	$
	Special Needs School/Program Placement:	$
	Independent School Applications:	$
	SSAT/PSAT/SAT/ACT session/s:	$
	LD Services/Placement &/or Urgency Services - additional fee:	$

	Enter the Total Amount:	$

VOLUNTEER CONTRIBUTION

Your Name:
Date of Birth:	[please use numbers only, in the following format: 08/07/87]

Please enter your contribution amount (USD only):
	Contribution:	$

E D U F A X can be reached at:
345 North Main Street, Suite 317, West Hartford, CT 06117
phone/fax: (860) 233-3900 ||| e-mail: edufax@edufax.com