Credit Card Form
Steam Engineering Institute
P.O. Box 69, Weymouth, MA 02188 web page: www.steamsei.com
Phone/FAX 781-843-2418 Email : steamsei@beld.net
MasterCard, Visa or Discover may be used to pay your full tuition.
This form will be shredded after bank approval.
Only full payment of tuition will be accepted by VISA , MasterCard or Discover.
This form will be shredded when payment clears bank.
Charge to: VISA ___ MasterCard ___ Discover ____
Total tuition charged: $ __________________
Card number: _____________________________________
Expiration Date: ____________________
Name on card: ____________________________________________________________
Address: _________________________________________________________________
City: ____________________________________________________________________
State: ______ ZIP: ____________________
Signature of cardholder: __________________________________________________
Date: _________________
Fill out all the information and mail this form with your enrollment agreement
